Sa1241 INSURANCE REIMBURSEMENT FOR PER-ORAL ENDOSCOPIC MYOTOMY AT HIGH-VOLUME ACADEMIC CENTER WITH A VARIED PAYER MIX

Abstract Per-oral endoscopic myotomy (POEM) is an effective treatment for achalasia. Efficacy is equivalent to Laparoscopic Heller’s myotomy with the advantage of minimal access and shorter length of stay. Post-operative reflux rates are higher in POEM. The Functional Luminal Imaging Probe (FLIP) allows the measurement of lower oesophageal distensibility during per-oral endoscopic myotomy. In theory, this enables the operator to tailor the myotomy to ensure adequate distensibility whilst minimising post-operative reflux risk. Methods Two prospectively collected POEM databases were analysed from 2 UK tertiary upper GI centres. The operators in each centre used intraoperative FLIP measurements to ensure adequate myotomy. Outcome measures included Eckardt score (where ≤3 indicated clinical success) and proton pump inhibitor use (PPI), collected at the first post-operative appointment. Length of stay was recorded, as were complications. Results 142 patients underwent POEM between 2015 and 2019 with 90% (128/142) clinical success. This improved to 93% (68/73) in the latter half of each series. 79% of the poor responders had previous interventions compared to 55% of responders (p = 0.09). Average post myotomy distensibility was 5.2 mm2/mmHg in responders and 3.11 in non-responders(p = 0.11). DI of >4.5 mm2/mmHg was associated with 100% clinical success. Myotomy length of <7 cm was associated with 93% clinical success and 40% post op PPI use compared to 60% with longer myotomies. There were 2 type IIIa, 2 type IIIb and one type IV Clavien-Dindo complications. Conclusion This study represents one of the largest UK series of FLIP tailored per-oral endoscopic myotomy. FLIP allows intraoperative monitoring of oesophageal distensibility allowing tailoring of myotomies. Tailored myotomies ≤6 cm were effective and were associated with less PPI use post operatively. Early referral of patients to high volume centres, where myotomies can be tailored using FLIP may lead to improved outcomes. More collaborative data from high volume centres is needed to decipher optimal myotomy profiles.

Download Full-text

PER-ORAL ENDOSCOPIC MYOTOMY (POEM) AND PER ORAL ENDOSCOPIC PYLOROMYOTOMY (POEP) FOR COEXISTING GASTROPARESIS AND ACHALASIA IN A SINGLE PATIENT PERFORMED AS A SINGLE PROCEDURE

10.1055/s-0038-1637361 ◽

2018 ◽

Author(s):

D Erhartova ◽

Z Vackova ◽

R Hustak ◽

J Spicak ◽

J Martinek

Keyword(s):

Single Patient ◽

Single Procedure ◽

Per Oral Endoscopic Myotomy ◽

Endoscopic Myotomy ◽

Per Oral

Download Full-text

THE NATURAL CLINICAL COURSE AFTER PER-ORAL ENDOSCOPIC MYOTOMY: IS MICROBIAL TRANSLOCATION THE KEY? A PROSPECTIVE RANDOMIZED CLINICAL TRIAL

10.1055/s-0040-1704307 ◽

2020 ◽

Author(s):

R Maselli ◽

A Oliva ◽

M Badalamenti ◽

PA Galtieri ◽

R Nicoletti ◽

...

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Clinical Course ◽

Microbial Translocation ◽

Prospective Randomized Clinical Trial ◽

Per Oral Endoscopic Myotomy ◽

Endoscopic Myotomy ◽

Per Oral

Download Full-text

Impact of per oral endoscopic myotomy on esophageal high resolution manometry parameters in patients with achalasia

10.26226/morressier.57c53841d462b80296c9c713 ◽

2016 ◽

Author(s):

Sabine Roman

Keyword(s):

High Resolution ◽

High Resolution Manometry ◽

Per Oral Endoscopic Myotomy ◽

Endoscopic Myotomy ◽

Per Oral

Download Full-text

Per Oral Endoscopic Myotomy: updated results from a United Kingdom case series

10.26226/morressier.59a6b34ad462b80290b5576e ◽

2017 ◽

Author(s):

Shraddha Gulati

Keyword(s):

United Kingdom ◽

Case Series ◽

Per Oral Endoscopic Myotomy ◽

Endoscopic Myotomy ◽

Per Oral

Download Full-text

Experience and Technique for Zenker's Diverticulum Per Oral Endoscopic Myotomy: Z-POEM

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1717127 ◽

2020 ◽

Author(s):

Eitan Podgaetz ◽

Vani Konda

Keyword(s):

Third Space ◽

Zenker’S Diverticulum ◽

Complication Rates ◽

Short Term ◽

Zenker's Diverticulum ◽

Per Oral Endoscopic Myotomy ◽

Endoscopic Myotomy ◽

Invasive Techniques ◽

Per Oral

Abstract Objective With the advent of minimally invasive surgery, incisionless surgery, and third-space endoscopy, the treatment for Zenker's diverticulum has also moved toward less invasive techniques Methods New incisionless per oral techniques can be applied for cricopharyngeal myotomy in Zenker's diverticulum. Results Five patients underwent Zenker's diverticulum per oral endoscopic myotomy (Z-POEM) without complications, minimal discomfort, and narcotic consumption, with complete resolution of their symptoms by history and Eckardt scores. Conclusions Z-POEM is performed entirely endoscopically with very little associated pain or complication rates, with short-term follow-up having excellent functional and symptomatic results.

Download Full-text