ABSTRACT
Background/Aims@#Per oral endoscopic myotomy (POEM) has been increasingly used for achalasia in Latin America, where Chagas disease is prevalent, and this makes POEM more challenging. The aim of this study was to determine the learning curve for POEM in Latin America. @*Methods@#Patients undergoing POEM in Latin America with a single operator were included from a prospective registry over 4 years. Non-linear regression and cumulative sum control chart (CUSUM) analyses were conducted for the learning curve. @*Results@#A total of 125 patients were included (52% male; mean age, 59 years), of which 80 had type II achalasia (64%), and 38 had Chagas disease (30%). The average pre-procedure and post-procedure Eckardt scores were 6.79 and 1.87, respectively. Technical success was achieved in 93.5% of patients, and clinical success was achieved in 88.8%. Adverse events occurred in 27 patients (22%) and included bleeding (4 patients), pneumothorax (4 patients), mucosal perforation (13 patients), mediastinitis (2 patients), and leakage (4 patients).The CUSUM chart showed a median procedure time of 97 min (range, 45-196 min), which was achieved at the 61st procedure. Procedure duration progressively decreased, with the last 10 procedures under 50 min approaching a plateau (p-value <0.01). @*Conclusions@#Mastering POEM in Latin America requires approximately 61 procedures for both POEM efficiency and to accomplish the procedure within 97 minutes.
ABSTRACT
Background/Aims@#Per oral endoscopic myotomy (POEM) has been increasingly used for achalasia in Latin America, where Chagas disease is prevalent, and this makes POEM more challenging. The aim of this study was to determine the learning curve for POEM in Latin America. @*Methods@#Patients undergoing POEM in Latin America with a single operator were included from a prospective registry over 4 years. Non-linear regression and cumulative sum control chart (CUSUM) analyses were conducted for the learning curve. @*Results@#A total of 125 patients were included (52% male; mean age, 59 years), of which 80 had type II achalasia (64%), and 38 had Chagas disease (30%). The average pre-procedure and post-procedure Eckardt scores were 6.79 and 1.87, respectively. Technical success was achieved in 93.5% of patients, and clinical success was achieved in 88.8%. Adverse events occurred in 27 patients (22%) and included bleeding (4 patients), pneumothorax (4 patients), mucosal perforation (13 patients), mediastinitis (2 patients), and leakage (4 patients).The CUSUM chart showed a median procedure time of 97 min (range, 45-196 min), which was achieved at the 61st procedure. Procedure duration progressively decreased, with the last 10 procedures under 50 min approaching a plateau (p-value <0.01). @*Conclusions@#Mastering POEM in Latin America requires approximately 61 procedures for both POEM efficiency and to accomplish the procedure within 97 minutes.
ABSTRACT
BACKGROUND/AIMS: Capsule endoscopy is a diagnostic method for evaluating the small bowel lumen and can detect undiagnosed lesions. The aim of this study was to evaluate the diagnostic yield and clinical impact of capsule endoscopy in patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain. METHODS: This study involved a retrospective analysis of prospectively collected data, maintained in a database. Patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain within the period of March 2012 to March 2014 were included. Capsule endoscopy was used to detect small bowel pathologies in both groups. RESULTS: Sixty-five patients (53.8% female) fulfilled the inclusion criteria and had a mean (±standard deviation) age of 50.9±15.9 years. Clinically significant lesions were detected via capsule endoscopy in 32.5% of the patients in the abdominal pain group and 54.5% of the patients in the diarrhea group. Overall, 48% of patients had small bowel pathologies detected during the capsule endoscopy study. Inflammatory lesions and villous atrophy were the most frequent lesions identified in 16.9% and 15.3% of patients in the abdominal pain and the diarrhea groups, respectively. CONCLUSIONS: Routine use of capsule endoscopy in patients with irritable bowel syndrome should not be recommended. However, in patients with refractory conditions, capsule endoscopy may identify abnormalities.