Introduction Peroral endoscopic myotomy (POEM) is a novel endoscopic procedure used to treat achalasia and other spastic esophageal disorders that is an alternative to Heller myotomy. We seek to define the learning curve of POEM for a foregut surgeon with no formal endoscopic or POEM training by analyzing different intraoperative factors in a single series. Methods and Procedures The first 38 consecutive patients undergoing POEM by a single foregut surgeon were included in this retrospective study. Inverse curve regression models were used to analyze total operative time (TOT) and total operative time per centimeter of myotomy (TOT-CM), in addition to other intraoperative variables. Clinical outcomes were reported as pre- and post-operative Eckardt Scores. Results All patients had type II achalasia with no post-operative complications observed. Eckardt scores improved postoperatively (median (range): 1 (0-4)) compared with the preoperative scores (10 (8-12)) (P < .001). The total operative time (median 76 minutes, range 51-129) decreased significantly over the course of the series (R2 = .38, P < .001), with a learning plateau at 70 minutes and a learning rate of 12 cases. Total operative time per centimeter of myotomy (median 7.08 min/cm, range 4.25 to 15.38) decreased over time (R2 = .45, P < .001), with a learning plateau at 7 minutes/cm and a learning rate of 12 cases. Conclusion The number of cases for a foregut surgeon to become proficient in a POEM procedure was found to be 12-14 cases. The learning curve for a POEM in a formally trained foregut surgeon may be comparable to an endoscopically trained interventionist.

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Figure 1. Statistical analysis of Chronic Liver Disease patients and Weight LossTable 1. Demographics Patients, n 24 Men, n (%) 9 (37.5%) Women, n (%) 15 (62.5%) Age, mean in years (std dev) 53 (1/-12.05) Hyperlipidemia, n (%) 17 (70.83%) HTN, n (%) 16 (66.67%) EtOH users, n (%) 13 (54.17%) Stage 0-2 fibrosis, n (%) 6 (25%) Stage 3 Fibrosis, n (%) 3 (12.5%) Stage 4 Fibrosis, n (%) 15 (62.5%) BMI on Fibroscan, mean (std dev) 35.7 (1/-9.9) BMI on Liver Biopsy, mean (std dev) 34.