{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T13:01:34Z","timestamp":1787662894091,"version":"build-2736575974"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T00:00:00Z","timestamp":1666742400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Reports on learning curve for peroral endoscopic myotomy (POEM) in therapeutic endoscopy nonexperts are limited. We aimed to assess the number of cases required to achieve POEM proficiency for endoscopic submucosal dissection (ESD) experts and nonexperts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective study at the largest POEM referral center in Japan. POEM between April 2014 and December 2020 were included. Nonexperts and ESD experts were divided by training phases: A, 1\u201320; B, 21\u201340; C, 41\u201360; D, 61\u201380; and E, 81\u2013100 cases. Primary outcome was operation time, and the phase to reach target time (83\u2009min) was investigated. Secondary outcomes were clinical success rate, adverse events, and post\u2010POEM gastroesophageal reflux disease (GERD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five hundred and sixty\u2010six cases were performed by 14 nonexperts, and 555 cases by 15 ESD experts. As the primary outcome, operation time in nonexperts was: A, 95 (79\u2013115.8); B, 86.5 (71\u2013105); C, 80 (70\u2013100); D, 73 (64.5\u2013100.5); and E, 73.5 (57.8\u201388.8)\u2009min, while in ESD experts: A, 90 (74\u2013128); B, 77 (70\u201392); and C, 77 (70\u201393.5)\u2009min (median [interquartile range]). Operation time decreased significantly as experience increased in both groups (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), and nonexperts required 41\u201360 cases to achieve proficiency, while experts required 21\u201340 cases. As secondary outcomes, in nonexperts, clinical success was 96.9\u2013100%, adverse events were 5.0\u20139.2%, symptomatic GERD was 11.8\u201326.5%, and proton pump inhibitor (PPI) intake was 11.5\u201318.7% in each phase. While in experts, clinical success was 96.2\u2013100%, adverse events were 3.0\u20135.8%, symptomatic GERD was 14.6\u201322.0%, and PPI intake was 12.6\u201317.9%. There were no significant differences among training phases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Non\u2010ESD experts require more cases to achieve proficiency in POEM. These results are useful for establishing POEM training programs and institutional implementation of the procedure.<\/jats:p><\/jats:sec>","DOI":"10.1111\/den.14435","type":"journal-article","created":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T07:49:39Z","timestamp":1663055379000},"page":"323-331","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Learning curve for peroral endoscopic myotomy in therapeutic endoscopy experts and nonexperts: Large single\u2010center experience"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5893-6552","authenticated-orcid":false,"given":"Yusuke","family":"Fujiyoshi","sequence":"first","affiliation":[{"name":"Digestive Diseases Center Showa University Koto Toyosu Hospital  Tokyo Japan"},{"name":"Division of Gastroenterology St. Michael's Hospital, University of Toronto  Toronto 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Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Nishikawa","sequence":"additional","affiliation":[{"name":"Digestive Diseases Center Showa University Koto Toyosu Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4773-8769","authenticated-orcid":false,"given":"Akiko","family":"Toshimori","sequence":"additional","affiliation":[{"name":"Digestive Diseases Center Showa University Koto Toyosu Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6126-5684","authenticated-orcid":false,"given":"Mayo","family":"Tanabe","sequence":"additional","affiliation":[{"name":"Digestive Diseases Center Showa University Koto Toyosu Hospital  Tokyo 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