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Leung LJ, Ma GK, Lee JK, Fukami N, Chang H, Svahn J, Xu MM, Lam S, Risbud A, Jue TL. Successful Design and Implementation of a POEM Program for Achalasia in an Integrated Healthcare System. Dig Dis Sci 2023; 68:2276-2284. [PMID: 36725765 PMCID: PMC9891752 DOI: 10.1007/s10620-023-07839-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/15/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Per Oral Endoscopic Myotomy (POEM) is a minimally invasive treatment for achalasia with results comparable to laparoscopic Heller myotomy (LHM). Studies have described the development of proficiency for endoscopists learning to perform POEM, and societies have defined educational and technical objectives for advanced endoscopy fellows in training. However, there is limited guidance on the organizational strategy and educational plan necessary to develop an achalasia service with POEM expertise. AIMS We aim to outline the steps for design and implementation of a successful POEM program. METHODS We reported our experience developing a multi-disciplinary clinical program for POEM and the steps taken to achieve procedural proficiency. We also reported our technical success (successful tunneling into the gastric cardia and myotomy of LES muscle fibers) and clinical success (post-procedure Eckardt score ≤ 3) at 3-6 months and 12 months post-procedure. Adverse events were classified per the ASGE lexicon for endoscopic adverse events. RESULTS After creating a multi-disciplinary clinical program for achalasia and completing procedural proficiency for POEM, our technical success rate was 100% and clinical success rate 90% for the first 41 patients. One adverse event (2.4%) occurred, moderate in severity per the American Society of Gastrointestinal Endoscopy (ASGE) lexicon for adverse endoscopic events. CONCLUSION In this study, we outlined the steps involved to establish a POEM service in a large integrated healthcare system. Prior competency in interventional endoscopy, procedural training models, POEM observation and education, proctorship, and interdisciplinary patient care are recommended.
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Affiliation(s)
- Lawrence Jun Leung
- grid.414890.00000 0004 0461 9476Department of Internal Medicine, Kaiser Permanente San Francisco, San Francisco, CA USA
| | - Gene K. Ma
- grid.492756.b0000 0004 0444 0628Department of Gastroenterology, Kaiser Permanente San Jose, San Jose, CA USA
| | - Jeffrey K. Lee
- grid.414890.00000 0004 0461 9476Department of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, CA USA
| | - Norio Fukami
- grid.417468.80000 0000 8875 6339Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ USA
| | - Howard Chang
- grid.414886.70000 0004 0445 0201Department of Gastroenterology, Kaiser Permanente Oakland, Oakland, CA USA
| | - Jonathan Svahn
- grid.414886.70000 0004 0445 0201Department of Surgery, Kaiser Permanente Oakland, Oakland, CA USA
| | - Ming-Ming Xu
- grid.280062.e0000 0000 9957 7758Department of Gastroenterology, Kaiser Permanente West LA, Los Angeles, CA USA
| | - Steven Lam
- grid.414890.00000 0004 0461 9476Department of Internal Medicine, Kaiser Permanente San Francisco, San Francisco, CA USA
| | - Amita Risbud
- grid.414890.00000 0004 0461 9476Department of Internal Medicine, Kaiser Permanente San Francisco, San Francisco, CA USA
| | - Terry L. Jue
- grid.414890.00000 0004 0461 9476Department of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, CA USA ,grid.417468.80000 0000 8875 6339Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ USA
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Hsu DS, Kumar NS, Le ST, Chang AL, Kazantsev G, Spitzer AL, Peng PD, Chang CK. Centralization of pancreatic cancer treatment within an integrated healthcare system improves overall survival. Am J Surg 2022; 223:1035-1039. [PMID: 34607651 DOI: 10.1016/j.amjsurg.2021.09.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/11/2021] [Accepted: 09/29/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Higher-volume centers for pancreatic cancer surgeries have been shown to have improved outcomes such as length of stay. We examined how centralization of pancreatic cancer care within a regional integrated healthcare system improves overall survival. METHODS We conducted a retrospective study of 1621 patients treated for pancreatic cancer from February 2010 to December 2018. Care was consolidated into 4 Centers of Excellence (COE) in surgery, medical oncology, and other specialties. Descriptive statistics, bivariate analysis, Chi-square tests, and Kaplan-Meier analysis were performed. RESULTS Neoadjuvant chemotherapy use rose from 10% to 31% (p < .001). The median overall survival (OS) improved by 3 months after centralization (p < .001), but this did not reach significance on multivariate analysis. CONCLUSIONS Our results suggest that in a large integrated healthcare system, centralization improves overall survival and neoadjuvant therapy utilization for pancreatic cancer patients.
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Affiliation(s)
- Diana S Hsu
- University of California, San Francisco - East Bay Surgery, Highland Hospital, 1411 E 31st St, Q1C 22134, Oakland, CA, 94602, USA; Department of Surgery, Kaiser Permanente-Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA.
| | - Nikathan S Kumar
- University of California, San Francisco - East Bay Surgery, Highland Hospital, 1411 E 31st St, Q1C 22134, Oakland, CA, 94602, USA; Department of Surgery, Kaiser Permanente-Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA
| | - Sidney T Le
- University of California, San Francisco - East Bay Surgery, Highland Hospital, 1411 E 31st St, Q1C 22134, Oakland, CA, 94602, USA; Department of Surgery, Kaiser Permanente-Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA
| | - Alex L Chang
- Department of Surgery, Kaiser Permanente-Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA
| | - George Kazantsev
- Department of Surgery, Kaiser Permanente-Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA
| | - Austin L Spitzer
- Department of Surgery, Kaiser Permanente-Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA
| | - Peter D Peng
- Department of Surgery, Kaiser Permanente-Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA
| | - Ching-Kuo Chang
- Department of Surgery, Kaiser Permanente-Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA
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