Discordance between high-resolution manometry, esophagoscopy and contrast esophagogram in determining landmarks for per-oral endoscopic myotomy in spastic esophageal disorders: a word of caution

2020 ◽  
Author(s):  
Luis Serrano ◽  
Adham R. Saad ◽  
Christoper DuCoin ◽  
John W. Jacobs ◽  
Joel E. Richter ◽  
...  
Keyword(s):  
High Resolution ◽  
High Resolution Manometry ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Per Oral

scholarly journals Clinical outcomes and safety of high-resolution manometry guided superficial partial circular muscle myotomy in per-oral endoscopic myotomy for Jackhammer esophagus: Two cases report

2019 ◽  
Vol 7 (16) ◽  
pp. 2322-2329
Author(s):  
Youn I Choi ◽  
Kyoung Oh Kim ◽  
Dong Kyun Park ◽  
Jun-Won Chung ◽  
Yoon Jae Kim ◽  
...  
Keyword(s):  
High Resolution ◽  
Clinical Outcomes ◽  
Circular Muscle ◽  
High Resolution Manometry ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Per Oral

Su1087 Impact of Per Oral Endoscopic Myotomy on Esophageal High Resolution Manometry Parameters in Patients With Achalasia

2016 ◽  
Vol 150 (4) ◽  
pp. S465
Author(s):  
Sabine Roman ◽  
Mathieu Pioche ◽  
Jerome Rivory ◽  
Aurélien Garros ◽  
Thierry Ponchon ◽  
...  
Keyword(s):  
High Resolution ◽  
High Resolution Manometry ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Per Oral

Myotomy length informed by high-resolution esophageal manometry (HREM) results in improved per-oral endoscopic myotomy (POEM) outcomes for type III achalasia

2018 ◽  
Vol 33 (3) ◽  
pp. 886-894 ◽  
Author(s):  
Erica D. Kane ◽  
Vikram Budhraja ◽  
David J. Desilets ◽  
John R. Romanelli
Keyword(s):  
High Resolution ◽  
Esophageal Manometry ◽  
Type Iii ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Type Iii Achalasia ◽  
Per Oral

PS01.020: OPTIMISTIC PATIENTS AND ITS HIDDEN PERILS: A REVIEW OF ACID REFLUX IN INDIVIDUALS POST PER-ORAL ENDOSCOPIC MYOTOMY (POEM)

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 55-56
Author(s):  
Tian Zhi Lim ◽  
Wei Qi Leong ◽  
Siok Chin Teo ◽  
Elya Chen ◽  
Guo Wei Kim ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Symptomatic Relief ◽  
Acid Reflux ◽  
Similar Efficacy ◽  
Acid Exposure ◽  
Type I ◽  
High Resolution Manometry ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Per Oral

Abstract Background Per-Oral Endoscopic Myotomy (POEM) has been adopted as a treatment option for Achalasia, with similar efficacy and safety profile as laparoscopic Heller Myotomy. However, issues of acid reflux and reflux oesophagitis have often plagued these patients. We aim to evaluate the clinical outcomes and resolution of reflux disease among individuals post-POEM. Methods A prospective review was performed for all patients who have undergone POEM from January 2014 to December 2017, with individuals analysed at the 1 year mark post-POEM. Subjective assessment of reflux was performed using self-administered questionnaires, with 24h pH impedence test and high resolution manometry providing objective correlation. Results Forty-three individuals underwent POEM during the 4 year period. The median age was 52 years (range, 24–78), with half being males (53.5%). The individuals had a median ASA score of 2 (range, 1–3). Majority of the individuals had type II achalasia (58.1%) followed by type I (34.9%) and type III (7%). Patients presented with dysphagia (88.4%) and reflux (10%); symptomatic for a median of 36 months (range, 3–540). One-third required the use of proton pump inhibitors (PPI) for symptomatic relief, with 35% receiving prior interventions for achalasia. These patients had a median Integrated Relaxation Pressure (IRP) of 23.6 mmHg (range, 4.6–160) and a median Eckardt score of 6 (range, 1 -11). One-third developed complications such as mucosal injury (18.6%), carbon dioxide pneumoperitoneum (16.3%) and bleeding (4.7%). The median length of stay was 3 days (range, 1–6). At the 1 year mark, 86% reported improvement in dysphagia (p: 0.043) with 66% having reduction in ratings for their severity (p: 0.002) and frequency (p: 0.05) of reflux. The median IRP (23 vs 13 mmHg) was also significantly lower (p: 0.005). However, only 38.5% correlated with a normal acid exposure on the impedence test (p: 0.592). Conclusion POEM is a promising solution in the management of achalasia given good clinical response for dysphagia and reflux. However, excessive lower oesophageal acid exposure may still be present in almost half of these patients, which may be alleviated with the use of long term use of PPI. Disclosure All authors have declared no conflicts of interest.

scholarly journals Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response

2021 ◽  
Vol 09 (11) ◽  
pp. E1692-E1701
Author(s):  
John M. DeWitt ◽  
Robert M. Siwiec ◽  
Anthony Perkins ◽  
Daniel Baik ◽  
William R. Kessler ◽  
...  
Keyword(s):  
Clinical Response ◽  
High Resolution Manometry ◽  
Per Oral Endoscopic Myotomy ◽  
Eckardt Score ◽  
Barium Esophagram ◽  
Endoscopic Myotomy ◽  
Grade 3 ◽  
Integrated Relaxation Pressure ◽  
And Function ◽  
Per Oral

Abstract Background and study aims The aim of this study was to evaluate whether timed barium esophagram within 24 hours post-per-oral endoscopic myotomy (POEM) (TBE-PP) could predict clinical outcomes. Patients and methods This was a single-center retrospective study of prospectively collected data on consecutive patients with ≥ 6-month follow-up who underwent POEM followed by TBE-PP. Esophageal contrast retention 2 minutes after TBE-PP was assessed as Grade 1 (< 10 %), 2 (10 %–49 %), 3 (50 %–89 %) or 4 (> 90 %). Eckardt score, esophagogastroduodenoscopy (EGD), high-resolution manometry (HRM) and function lumen imaging probe (FLIP) of the esophagogastric junction (EGJ) were obtained at baseline. These tests along with pH testing of antisecretory therapy were repeated 6 and 24 months after POEM. Clinical response by Eckardt score ≤ 3, EGJ-distensibility index (EGJ-DI) > 2.8 mm2/mm Hg, and integrated relaxation pressure (IRP) < 15 mm Hg and incidence of gastroesophageal reflux disease (GERD) were compared by transit time. Results Of 181 patients (58 % male, mean 53 ± 17 yr), TBE-PP was classified as Grade 1 in 122 (67.4 %), Grade 2 in 41 (22.7 %), Grade 3 in 14 (7.7 %) and Grade 4 in 4 (2.2 %). At 6 months, overall clinical response by ES (91.7 %), IRP (86.6 %), EGJ-DI (95.7 %) and the diagnosis of GERD (68.6 %) was similar between Grade 1 and Grade 2–4 TBE-PP. At 24 months, Grade 1 had a higher frequency of a normal IRP compared to Grades 2–4 (95.7 % vs. 60 %, P = 0.021) but overall response by ES (91.2 %), EGJ-DI (92.3 %) and the diagnosis of GERD (74.3 %) were similar. Conclusions Contrast emptying rate by esophagram after POEM has limited utility to predict clinical response or risk of post-procedure GERD.

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