Endoscopic management of achalasia cardia: a regional approach for per oral endoscopic myotomy (POEM) in the Northern Region – lessons learnt in developing a service

Introduction Per oral endoscopic myotomy (POEM) for achalasia is available in many but not all areas of the UK; this article maps lessons learnt in bringing POEM to the Northern Region of the UK. Novice to independent practice Over a 6-year period, the journey of the team delivering POEM in the Northern Region is described from inception to independent practice. Both expert trainers and expert nurses visited the team in person and remotely to support training in the POEM procedure. Learning structure framework A learning framework is described with both knowledge and skills required to be able to perform the procedure independently. Teams contributing to a safe and high-quality POEM service The Northern POEM team contributed to the safe and effective delivery of the service. Members of this team are described and their importance and contribution are detailed. Outcomes 38 procedures have been performed, with no major intra-procedural complications. Five conservatively managed leaks occurred at contrast swallow on day 1 post-POEM and one was readmitted with pleural effusion requiring drainage. Four patients required further intervention post-POEM. Trainer recommendations Both technical and non-technical training skills specific to the POEM procedure and generic peer-to-peer advanced endoscopy training are described. Conclusion To bring the POEM procedure to a region, a team mentality is preferred. Team members (endoscopists, nurses, anaesthetists, multi-disciplinary team, referrers) need to upskill together to provide a safe and effective service. Learning structures and teaching structures and the importance of team members are discussed to support other regions in developing the procedure.