Peroral endoscopic myotomy (POEM) is an advanced endoscopic procedure that has become a first-line treatment for esophageal achalasia and other esophageal spastic disorders. Structured training is essential to optimize the outcomes of this technique. The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in POEM. This Position Statement presents the results of a systematic review of the literature and a formal Delphi process, providing recommendations for an optimal training program in POEM that aims to produce endoscopists competent in this procedure. In a separate document (POEM curriculum Part II), we provide technical guidance on how to perform the POEM procedure based on the best available evidence. 1: POEM trainees should acquire a comprehensive theoretical knowledge of achalasia and other esophageal motility disorders that encompasses pathophysiology, diagnostic tool proficiency, clinical outcome assessment, potential adverse events, and periprocedural management. 2: Experience in advanced endoscopic procedures (endoscopic mucosal resection and/or endoscopic submucosal dissection [ESD]) is encouraged as a beneficial prerequisite for POEM training. 3: ESGE suggests that POEM trainees without ESD experience should perform an indicative minimum number of 20 cases on ex vivo or animal models before advancing to human POEM cases with an experienced trainer. 4: ESGE recommends that the trainee should observe an indicative minimum number of 20 live cases at expert centers before starting to perform POEM in humans. 5: The trainee should undertake an indicative minimum number of 10 cases under expert supervision for the initial human POEM procedures, ensuring that trainees can complete all POEM steps independently. 6: ESGE recommends avoiding complex POEM cases during the early training phase. 7: POEM competence should reflect the technical success rate, both the short- and long-term clinical success rates, and the rate of true adverse events. 8: A POEM center should maintain a prospective registry of all procedures performed, including patient work-up and outcomes, procedural techniques, and adverse events.

Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas Madrid Spain

Clarunis Universitäres Bauchzentrum Basel Switzerland

Clinical Medicine University of California San Francisco California USA

Department of Gastroenterology and Hepatology Amsterdam UMC Amsterdam The Netherlands

Department of Gastroenterology and Hepatology Hospital Universitario Ramón y Cajal Madrid Spain

Department of Gastroenterology and Hepatology St Anne University Hospital Brno Czech Republic

Department of Gastroenterology and Hepatology University Hospital of Ghent Ghent Belgium

Department of Gastroenterology and Hepatology UZ Leuven Leuven Belgium

Department of Gastroenterology University Hospital Augsburg Augsburg Germany

Department of Gastrointestinal Endoscopy Military University Hospital Prague Prague Czech Republic

Department of Translational Research in Gastrointestinal Diseases KU Leuven Leuven Belgium

Digestive Endoscopy Unit Fondazione Policlinico Universitario A Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy

Division of Gastroenterology Ulster Hospital Belfast Northern Ireland

Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology Emek Medical Center Afula Israel

Endoscopy and Motility Unit Gastroenterology Department Hospital Clinic de Barcelona Barcelona Spain

Gastroenterology Department Centro Hospitalar S João Porto Portugal

Gastroenterology Department Hospital Universitario de Navarra Navarrabiomed UPNA IdiSNA Pamplona Spain

Gastrointestinal Endoscopy Unit Hospital das Clínicas of the University of São Paulo Medical School São Paulo Brazil

Instituto Ramón y Cajal de Investigación Sanitaria Madrid Spain

Pancreatobiliary Endoscopy Services Division of Digestive and Liver Disease Columbia University Irving Medical Center New York New York USA

Rappaport Faculty of Medicine Technion Israel Institute of Technology Haifa Israel

University Clinic Zaporizhzhia State Medical and Pharmaceutical University Zaporizhzhia Ukraine

University of Medicine and Pharmacy Iuliu Hatieganu Cluj Napoca Romania

Waikato Hospital Hamilton New Zealand

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