"Efekt u\u010Den\u00ED peror\u00E1ln\u00ED endoskopick\u00E9 myotomie (POEM) b\u011Bhem prvn\u00EDho roku ov\u011B\u0159ov\u00E1n\u00ED metody v \u010Cesk\u00E9 republice" . "Effect of learning peroral endoscopic myotomy (POEM) during the first year of authentication methods in the Czech Republic"@en . "Efekt u\u010Den\u00ED peror\u00E1ln\u00ED endoskopick\u00E9 myotomie (POEM) b\u011Bhem prvn\u00EDho roku ov\u011B\u0159ov\u00E1n\u00ED metody v \u010Cesk\u00E9 republice"@cs . . . "Gastroenterologie a hepatologie" . . . . "Peror\u00E1ln\u00ED endoskopick\u00E1 myotomie (POEM) je novou (v \u010CR experiment\u00E1ln\u00ED) metodou l\u00E9\u010Dby achal\u00E1zie j\u00EDcnu. Jeliko\u017E lze p\u0159edpokl\u00E1dat jej\u00ED dal\u0161\u00ED roz\u0161\u00ED\u0159en\u00ED do klinick\u00E9 praxe a optimalizace tr\u00E9ninku l\u00E9ka\u0159\u016F prov\u00E1d\u011Bj\u00EDc\u00EDch POEM je kl\u00ED\u010Dov\u00E1, sledovali jsme efekt u\u010Den\u00ED b\u011Bhem prvn\u00EDho roku prov\u00E1d\u011Bn\u00ED POEM v \u010CR. Metody: Prospektivn\u00ED studie \u010D\u00EDtala 30 pacient\u016F s achal\u00E1zi\u00ED, kte\u0159\u00ED podstoupili POEM. V\u0161echny operace provedl jeden endoskopista po observaci dev\u00EDti v\u00FDkon\u016F u experta a po p\u0159edchoz\u00EDm tr\u00E9ninku na deseti prasatech. Pacienti byli rozd\u011Bleni do t\u0159\u00ED po sob\u011B jdouc\u00EDch homogenn\u00EDch skupin (n = 10). Efekt zlep\u0161en\u00ED jsme hodnotili pomoc\u00ED \u010Dasu nezbytn\u00E9ho k vytvo\u0159en\u00ED 1cm myotomie, \u010Detnosti v\u00FDskytu technick\u00FDch chyb (nec\u00EDlen\u00E9 poran\u011Bn\u00ED sliznice, extravazace CO2) a peropera\u010Dn\u00EDch komplikac\u00ED. V\u00FDsledky: POEM byla v\u017Edy dokon\u010Dena \u00FAsp\u011B\u0161n\u011B bez z\u00E1va\u017En\u00E9 komplikace. Pacienti (n = 30; ve v\u011Bku 47,3 ? 14,5 let; BMI 24,9 ? 3,7 kg/m2) byli hospitalizov\u00E1ni 2,5 ? 0,7 dne. \u010Cas nutn\u00FD k vytvo\u0159en\u00ED 1cm myotomie \u010Dinil pr\u016Fm\u011Brn\u011B 7,7 ? 2,7 min a s p\u0159ib\u00FDvaj\u00EDc\u00EDmi zku\u0161enostmi signifikantn\u011B klesal (p < 0,001). V\u00FDskyt ne\u00FAmysln\u00E9 mukozotomie (n = 3; 10 %) ve skupin\u00E1ch klesal (0,2; 0,1; 0), ale pokles nebyl signifikantn\u00ED (p = 0,75). Celkem 13 pacient\u016F (43 %) si vy\u017E\u00E1dalo dekompresi kapnoperitonea a u dal\u0161\u00EDch sedmi pacient\u016F (23 %) se objevil podko\u017En\u00ED emfyz\u00E9m, kter\u00FD spont\u00E1nn\u011B odezn\u011Bl. Oba typy extravazace CO2 nebyly ovlivn\u011Bny na\u0161\u00EDm u\u010Den\u00EDm (p = 1). K\u0159ivka u\u010Den\u00ED prok\u00E1zala v\u00FDrazn\u00E9 zlep\u0161en\u00ED od 12. klinick\u00E9ho POEM v\u00FDkonu. Plateau f\u00E1ze se pln\u011B stabilizovala od 14. klinick\u00E9ho POEM v\u00FDkonu. Z\u00E1v\u011Bry: B\u011Bhem prvn\u00EDho roku pou\u017E\u00EDv\u00E1n\u00ED POEM v klinick\u00E9 praxi jsme zaznamenali v\u00FDznamn\u00FD efekt u\u010Den\u00ED ve sni\u017Eov\u00E1n\u00ED opera\u010Dn\u00EDho \u010Dasu s rychlej\u0161\u00EDm proveden\u00EDm myotomie. Technick\u00E9 chyby p\u0159i v\u00FDkonu nebyly prim\u00E1rn\u011B u\u010Den\u00EDm ovlivn\u011Bny. Auto\u0159i d\u016Frazn\u011B doporu\u010Duj\u00ED prov\u00E1d\u011Bn\u00ED metody POEM v klinick\u00E9 praxi a\u017E po \u0159\u00E1dn\u00E9m tr\u00E9ninku (na prasatech) a po observaci v\u00FDkonu v expertn\u00EDch centrech. Ke komplexn\u00ED p\u0159ipravenosti a zvl\u00E1dnut\u00ED POEM techniky doch\u00E1z\u00ED po cca 23 v\u00FDkonech."@cs . "Peroral endoscopic myotomy (POEM) is a new (experimental in the Czech Republic) method for treating esophageal achalasia. Since we can assume that its further expansion into clinical practice and the optimization of the training of doctors performing POEM is crucial, we have analyzed the learning curve during the first year of POEM implementation in our country. Methods: The prospective study consisted of 30 patients with achalasia who underwent POEM. All surgeries were carried out by one endoscopist who had observed nine clinical performances by an expert endoscopist and trained on ten pigs. Patients were divided into three consecutive homogeneous groups (n = 10). The degree of improvement was assessed according to the time necessary to perform a 1cm myotomy, the frequency of technical errors (non-targeted mucosal injury, CO2 extravasations) and intra-surgery complications. Results: POEM was completed successfully in all cases without any major complications. Patients (n = 30; mean age 47.3 ? 14.5 years; BMI 24.9 ? 3.7 kg/m2) were hospitalized 2.5 ? 0.7 days. The average time required to perform a 1cm myotomy was 7.7 ? 2.7 minutes, and as we gained experience this time significantly decreased (p < 0.001). The frequency of unintentional mucosotomy (n = 3; 10%) declined in groups (0.2; 0.1; 0), but the decrease was not significant (p = 0.75). A total of 13 patients (43%) required capnoperitoneum decompression. Subcutaneous emphysema with spontaneous resolution appeared in seven patients (23%). Neither type of CO2 extravasation was affected by our learning (p = 1). The learning curve began to show a significant improvement from the performance of the 12th clinical POEM and a plateau was reached after the 14th clinical performance. Conclusions: During the first year of using POEM in clinical practice we observed a significant learning effect in operating time reduction with faster performance of myotomy. Technical errors were primarily not affected by learning."@en . "5"^^ . . . "11130" . . "13048" . "RIV/00216208:11130/14:10293294" . "Peror\u00E1ln\u00ED endoskopick\u00E1 myotomie (POEM) je novou (v \u010CR experiment\u00E1ln\u00ED) metodou l\u00E9\u010Dby achal\u00E1zie j\u00EDcnu. Jeliko\u017E lze p\u0159edpokl\u00E1dat jej\u00ED dal\u0161\u00ED roz\u0161\u00ED\u0159en\u00ED do klinick\u00E9 praxe a optimalizace tr\u00E9ninku l\u00E9ka\u0159\u016F prov\u00E1d\u011Bj\u00EDc\u00EDch POEM je kl\u00ED\u010Dov\u00E1, sledovali jsme efekt u\u010Den\u00ED b\u011Bhem prvn\u00EDho roku prov\u00E1d\u011Bn\u00ED POEM v \u010CR. Metody: Prospektivn\u00ED studie \u010D\u00EDtala 30 pacient\u016F s achal\u00E1zi\u00ED, kte\u0159\u00ED podstoupili POEM. V\u0161echny operace provedl jeden endoskopista po observaci dev\u00EDti v\u00FDkon\u016F u experta a po p\u0159edchoz\u00EDm tr\u00E9ninku na deseti prasatech. Pacienti byli rozd\u011Bleni do t\u0159\u00ED po sob\u011B jdouc\u00EDch homogenn\u00EDch skupin (n = 10). Efekt zlep\u0161en\u00ED jsme hodnotili pomoc\u00ED \u010Dasu nezbytn\u00E9ho k vytvo\u0159en\u00ED 1cm myotomie, \u010Detnosti v\u00FDskytu technick\u00FDch chyb (nec\u00EDlen\u00E9 poran\u011Bn\u00ED sliznice, extravazace CO2) a peropera\u010Dn\u00EDch komplikac\u00ED. V\u00FDsledky: POEM byla v\u017Edy dokon\u010Dena \u00FAsp\u011B\u0161n\u011B bez z\u00E1va\u017En\u00E9 komplikace. Pacienti (n = 30; ve v\u011Bku 47,3 ? 14,5 let; BMI 24,9 ? 3,7 kg/m2) byli hospitalizov\u00E1ni 2,5 ? 0,7 dne. \u010Cas nutn\u00FD k vytvo\u0159en\u00ED 1cm myotomie \u010Dinil pr\u016Fm\u011Brn\u011B 7,7 ? 2,7 min a s p\u0159ib\u00FDvaj\u00EDc\u00EDmi zku\u0161enostmi signifikantn\u011B klesal (p < 0,001). V\u00FDskyt ne\u00FAmysln\u00E9 mukozotomie (n = 3; 10 %) ve skupin\u00E1ch klesal (0,2; 0,1; 0), ale pokles nebyl signifikantn\u00ED (p = 0,75). Celkem 13 pacient\u016F (43 %) si vy\u017E\u00E1dalo dekompresi kapnoperitonea a u dal\u0161\u00EDch sedmi pacient\u016F (23 %) se objevil podko\u017En\u00ED emfyz\u00E9m, kter\u00FD spont\u00E1nn\u011B odezn\u011Bl. Oba typy extravazace CO2 nebyly ovlivn\u011Bny na\u0161\u00EDm u\u010Den\u00EDm (p = 1). K\u0159ivka u\u010Den\u00ED prok\u00E1zala v\u00FDrazn\u00E9 zlep\u0161en\u00ED od 12. klinick\u00E9ho POEM v\u00FDkonu. Plateau f\u00E1ze se pln\u011B stabilizovala od 14. klinick\u00E9ho POEM v\u00FDkonu. Z\u00E1v\u011Bry: B\u011Bhem prvn\u00EDho roku pou\u017E\u00EDv\u00E1n\u00ED POEM v klinick\u00E9 praxi jsme zaznamenali v\u00FDznamn\u00FD efekt u\u010Den\u00ED ve sni\u017Eov\u00E1n\u00ED opera\u010Dn\u00EDho \u010Dasu s rychlej\u0161\u00EDm proveden\u00EDm myotomie. Technick\u00E9 chyby p\u0159i v\u00FDkonu nebyly prim\u00E1rn\u011B u\u010Den\u00EDm ovlivn\u011Bny. Auto\u0159i d\u016Frazn\u011B doporu\u010Duj\u00ED prov\u00E1d\u011Bn\u00ED metody POEM v klinick\u00E9 praxi a\u017E po \u0159\u00E1dn\u00E9m tr\u00E9ninku (na prasatech) a po observaci v\u00FDkonu v expertn\u00EDch centrech. Ke komplexn\u00ED p\u0159ipravenosti a zvl\u00E1dnut\u00ED POEM techniky doch\u00E1z\u00ED po cca 23 v\u00FDkonech." . "1804-7874" . "Juh\u00E1sov\u00E1, Jana" . "1"^^ . "\u0160vecov\u00E1, H." . . "intra-surgery complications; learning curve; esophageal achalasia; peroral endoscopic myotomy"@en . . . "http://www.prolekare.cz/ceska-slovenska-gastro-clanek/efekt-uceni-peroralni-endoskopicke-myotomie-poem-behem-prvniho-roku-overovani-metody-v-ceske-republice-50281" . "Efekt u\u010Den\u00ED peror\u00E1ln\u00ED endoskopick\u00E9 myotomie (POEM) b\u011Bhem prvn\u00EDho roku ov\u011B\u0159ov\u00E1n\u00ED metody v \u010Cesk\u00E9 republice" . "[F36558C84B50]" . "5"^^ . . "Effect of learning peroral endoscopic myotomy (POEM) during the first year of authentication methods in the Czech Republic"@en . "Mart\u00EDnek, Jan" . "RIV/00216208:11130/14:10293294!RIV15-MSM-11130___" . "CZ - \u010Cesk\u00E1 republika" . "I, V" . "Dole\u017Eel, Radek" . "68" . . "4" . "\u0160pi\u010D\u00E1k, Julius" . . . "Efekt u\u010Den\u00ED peror\u00E1ln\u00ED endoskopick\u00E9 myotomie (POEM) b\u011Bhem prvn\u00EDho roku ov\u011B\u0159ov\u00E1n\u00ED metody v \u010Cesk\u00E9 republice"@cs . .