scholarly journals Sa1901 REFRACTORY GASTROPARESIS: GASTRIC PERORAL ENDOSCOPIC MYOTOMY (G-POEM) VS. INTRAPYLORIC BOTULINUM TOXIN INJECTION

2018 ◽  
Vol 87 (6) ◽  
pp. AB241-AB242
Author(s):  
Nasim Parsa ◽  
Juliana Yang ◽  
Olaya I. Brewer Gutierrez ◽  
Robert Moran ◽  
Omid Sanaei ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Peroral Endoscopic Myotomy ◽  
Endoscopic Myotomy

Outcomes of Peroral Endoscopic Myotomy After Previously Failed Botulinum Toxin Injection and/or Pneumatic Dilation

2017 ◽  
Vol 112 ◽  
pp. S453
Author(s):  
Sarah Z. Maher ◽  
Jayakrishna Chintanaboina ◽  
Eric Pauli ◽  
Jennifer L. Maranki ◽  
Abraham Mathew
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Peroral Endoscopic Myotomy ◽  
Pneumatic Dilation ◽  
Endoscopic Myotomy

scholarly journals Gastric peroral endoscopic myotomy for gastroparesis, after botulinum toxin injection

Endoscopy ◽  
2017 ◽  
Vol 49 (10) ◽  
pp. E256-E257 ◽  
Author(s):  
Monica Saumoy ◽  
Najib Nassani ◽  
Joaquin Ortiz ◽  
Viviana Parra ◽  
Amy Tyberg ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Peroral Endoscopic Myotomy ◽  
Endoscopic Myotomy

Type II achalasia is associated with a comparably favorable outcome following per oral endoscopic myotomy

2020 ◽  
Author(s):  
Yutaka Tomizawa ◽  
Nadim Mahmud ◽  
Kevin Dasher ◽  
Joseph R Triggs ◽  
Monica Saumoy ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Clinical Success ◽  
Botulinum Toxin Injection ◽  
Motility Disorder ◽  
Favorable Outcome ◽  
Type Ii ◽  
Esophageal Motility Disorder ◽  
Treatment Naïve ◽  
Endoscopic Myotomy ◽  
Per Oral

Summary Per oral endoscopic myotomy (POEM) is a safe and effective treatment for esophageal motility disorder in treatment-naïve patients as well as salvage therapy. Though type II achalasia, compared to other subtypes, is reported to have a more favorable outcome with pneumatic dilation (PD) or Heller myotomy (HM), it is unclear whether achalasia subtype predicts symptom response to POEM. We aimed to evaluate whether type II achalasia is associated with a comparably favorable outcome following POEM. We performed a retrospective review of patients with esophageal motility disorder who were referred for POEM from April 2014 to June 2017. The main outcome was clinical success based on Eckardt score ≤3 and its association with subtype and safety. A total of 63 patients (mean age 51 years [SD 15]; 63% male) underwent a total of 68 POEMs with median of 263 days follow-up. Of these, 45 (71.3%) patients were type II achalasia. In all, 29 (46%) patients were treatment-naïve and 34 (54%) patients had previous endoscopic or surgical therapy including botulinum toxin injection in 16 (25%), PD in 10 (16%), both botulinum toxin injection and PD in 8 (13%) and HM in 3 (5%). Technical success was 100% and clinical success was achieved in 51 (81%) patients. The rate of clinical success was higher in patients with type II achalasia compared to the other subtypes (88.9% vs. 61.1% [P = 0.028]) and type II achalasia patients required fewer redo POEM (2.2% vs. 22.2% [P = 0.021]). Multivariate logistic regression analysis demonstrated the positive prediction of clinical success for type II achalasia following POEM (P = 0.046). As observed with PD and HM, type II achalasia was associated with a favorable clinical outcome following POEM.

Outcomes of peroral endoscopic myotomy in patients with achalasia and prior bariatric surgery: A multicenter experience

2021 ◽  
Author(s):  
S Bomman ◽  
J S Klair ◽  
M Ashat ◽  
R El Abiad ◽  
H Gerke ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Clinical Success ◽  
Botulinum Toxin Injection ◽  
Clinical Success Rate ◽  
Peroral Endoscopic Myotomy ◽  
Pneumatic Dilation ◽  
Type I ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
The Mean

Summary Peroral endoscopic myotomy (POEM) in patients with achalasia who are status post bariatric surgery may be technically challenging due to postsurgical scarring and altered anatomy. The aim of the study was to assess the efficacy and safety of POEM for achalasia in patients with prior bariatric surgery. A review of prospectively maintained databases at three tertiary referral centers from January 2015 to January 2021 was performed. The primary outcome of interest was clinical success, defined as a post-treatment Eckardt score ≤ 3 or improvement in Eckardt score by ≥ 1 when the baseline score was <3, and improvement of symptoms. Secondary outcomes were adverse event rates and symptom recurrence. Sixteen patients status post Roux-en-Y gastric bypass (n = 14) and sleeve gastrectomy (n = 2) met inclusion criteria. Indications for POEM were achalasia type I (n = 2), type II (n = 9), and type III (n = 5). POEM was performed either by anterior or posterior approach. The pre-POEM mean integrated relaxation pressure was 26.2 ± 7.6 mm Hg. The mean total myotomy length was 10.2 ± 2.7 cm. The mean length of hospitalization was 1.4 ± 0.7 days. Pre- and postprocedure Eckardt scores were 6.1 ± 2.1 and 1.7 ± 1.8, respectively. The overall clinical success rate was 93.8% (15/16) with mean follow-up duration of 15.5 months. One patient had esophageal leak on postprocedure esophagram and managed endoscopically. Dysphagia recurred in two patients, which was successfully managed with pneumatic dilation with or without botulinum toxin injection. POEM appears to be safe and effective in the management of patients with achalasia who have undergone prior bariatric surgery.

scholarly journals Endoscopic management of gastrointestinal motility disorders – part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopy ◽  
2020 ◽  
Vol 52 (06) ◽  
pp. 498-515 ◽  
Author(s):  
Bas L. A. M. Weusten ◽  
Maximilien Barret ◽  
Albert J. Bredenoord ◽  
Pietro Familiari ◽  
Jan-Michel Gonzalez ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Peroral Endoscopic Myotomy ◽  
High Quality ◽  
Strong Recommendation ◽  
Quality Of Evidence ◽  
Motility Disorders ◽  
Evidence Level ◽  
Endoscopic Myotomy ◽  
Level Of Agreement

Main RecommendationsESGE recommends the use of a graded pneumatic dilation protocol in achalasia, starting with a 30-mm dilation and followed by a 35-mm dilation at a planned interval of 2 – 4 weeks, with a subsequent 40-mm dilation when there is insufficient relief, over both a single balloon dilation procedure or the use of a larger balloon from the outset.Strong recommendation, high quality of evidence, level of agreement 100 %.ESGE recommends being cautious in treating spastic motility disorders other than achalasia with peroral endoscopic myotomy (POEM).Strong recommendation, very low quality of evidence, level of agreement 87.5 %.ESGE recommends against the routine use of botulinum toxin injections to treat patients with non-achalasia hypercontractile esophageal motility disorders (Jackhammer esophagus, distal esophageal spasm). However, if, in individual patients, endoscopic injection of botulinum toxin is chosen, ESGE recommends performing injections into four quadrants of the lower esophageal sphincter and in the lower third of the esophagus.Strong recommendation, low quality of evidence, level of agreement 78.6 %.ESGE recommends that endoscopic pylorus-directed therapy should be considered only in patients with symptoms suggestive of gastroparesis in combination with objective proof of delayed gastric emptying using a validated test, and only when medical therapy has failed.Strong recommendation, very low quality of evidence, level of agreement 100 %.ESGE recommends against the use of botulinum toxin injection in the treatment of unselected patients with gastroparesis. Strong recommendation, high quality of evidence, level of agreement 92.9 %.ESGE recommends consideration of gastric peroral endoscopic myotomy (G-POEM) in carefully selected patients only, because it is an emerging procedure with limited data on effectiveness, safety, and durability. G-POEM should be performed in expert centers only, preferably in the context of a clinical trial.Strong recommendation, low quality of evidence, level of agreement 100 %.

scholarly journals Insights into the endoscopic management of esophageal achalasia

2021 ◽  
Vol 14 ◽  
pp. 263177452110147
Author(s):  
Elizabeth Brindise ◽  
Mouen A. Khashab ◽  
Rami El Abiad
Keyword(s):  
Esophagogastric Junction ◽  
Botulinum Toxin Injection ◽  
Esophageal Achalasia ◽  
Peroral Endoscopic Myotomy ◽  
Inhibitory Neurons ◽  
Treatment Modalities ◽  
Endoscopic Management ◽  
Pneumatic Dilation ◽  
Esophageal Motility Disorder ◽  
Endoscopic Myotomy

Achalasia is a primary esophageal motility disorder characterized by the loss of inhibitory neurons in the myenteric plexus, resulting in impaired relaxation of the esophagogastric junction. Achalasia is an incurable disease, and the treatment modalities are aimed at disruption of the esophagogastric junction and vary widely from pharmacological to endoscopic to surgical. Traditional endoscopic therapy includes pneumatic dilation, botulinum toxin injection, and peroral endoscopic myotomy. This review aims to provide an overview of the endoscopic management of achalasia, while focusing on the utilization of peroral endoscopic myotomy and other novel approaches.

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