Peroral endoscopic myotomy for the treatment of achalasia patients with Roux-en-Y gastric bypass anatomy

Endoscopy ◽  
2018 ◽  
Vol 51 (04) ◽  
pp. 342-345 ◽  
Author(s):  
Omid Sanaei ◽  
Peter Draganov ◽  
Rastislav Kunda ◽  
Dennis Yang ◽  
Mouen Khashab
Keyword(s):  
Gastric Bypass ◽  
Clinical Success ◽  
Length Of Hospital Stay ◽  
Peroral Endoscopic Myotomy ◽  
Tunnel Length ◽  
Submucosal Tunnel ◽  
Eckardt Score ◽  
Exposure Testing ◽  
Endoscopic Myotomy ◽  
The Mean

Abstract Background The outcome of peroral endoscopic myotomy (POEM) in patients with prior Roux-en-Y gastric bypass (RYGB) is not known and some experts have recommended against its performance in this patient population because of the risk of postoperative regurgitation. The aim of this study was to report on the outcomes of POEM in patients with RYGB anatomy. Methods Patients with RYGB anatomy who underwent POEM for the treatment of achalasia at three tertiary centers were included. POEM was performed in standard fashion using the anterior or posterior approach. Clinical response was defined by a decrease in Eckardt score to ≤ 3. Results of esophageal acid exposure testing/pH-impedance and manometric testing after POEM were reported when available. Results A total of 10 achalasia patients with prior RYGB surgery underwent POEM. All procedures were technically successful with anterior myotomy performed in seven patients. The mean submucosal tunnel length and myotomy length were 12.9 cm and 11.1 cm, respectively. The mean procedure time was 72 minutes and mean length of hospital stay was 1.5 days. Clinical success was achieved in all 10 patients with a significant decrease in Eckardt score from 6.5 to 1 (P < 0.001). None of the patients experienced post-procedural regurgitation. Post-procedural pH testing was obtained in six patients and was normal in all of them. Conclusions This study suggests the feasibility, safety, and efficacy of POEM in patients with prior RYGB surgery. The risk of gastroesophageal reflux disease in these patients seems to be minimal after 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 &lt;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 Peroral Endoscopic Myotomy in the Management of Zenker’s Diverticulum: A Retrospective Multicenter Study

2021 ◽  
Vol 10 (2) ◽  
pp. 187
Author(s):  
Aleksandra Budnicka ◽  
Władysław Januszewicz ◽  
Andrzej B. Białek ◽  
Michal Spychalski ◽  
Jaroslaw Reguła ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Outcome Measures ◽  
Clinical Success ◽  
Length Of Hospital Stay ◽  
Peroral Endoscopic Myotomy ◽  
Technical Success ◽  
Treatment Naïve ◽  
Endoscopic Myotomy ◽  
The Mean

Background: Peroral endoscopic myotomy (POEM) is an emerging technique in the treatment of Zenker’s diverticulum (ZD). This study aimed to analyze the feasibility of Zenker’s POEM (Z-POEM) in a multicenter setting and assess its performance using a validated Kothari-Haber Scoring System newly developed for symptom measurement in ZD. Materials and methods: This was a multicenter retrospective study involving three Polish tertiary referral endoscopic units. The data of consecutive patients with symptomatic ZD treated with Z-POEM in Poland between May 2019 and August 2020 were retrieved and analyzed. Primary outcome measures were technical success and clinical success rate (<3 points in Kothari-Haber Score at 2–3 months follow-up). Secondary outcome measures included procedures’ duration, length of hospital stay, and adverse events. Results: 22 patients with symptomatic ZD were included. The mean age was 67.6 (±10.7) years, and 14 (63.6%) were male. All but two patients were treatment naïve. The average size of the ZD was 30 mm (IQR, 24–40 mm). Technical success was achieved in all patients (100%), whereas clinical success was 90.9%. The average Kothari-Haber Score was 6.35 before treatment and has dropped to 0.65 after the treatment (p < 0.0001). The mean procedure time was 48.8 (±19.3) minutes, and the median length of hospital stay was 2 days (IQR, 2–3). Three patients (13.6%) had post-procedural emphysema, of which two were mild and self-resolving (9.1%), and one was moderate (4.5%) and complicated with laryngeal edema and prolonged intubation. Conclusions: This feasibility study suggests that Z-POEM is a highly effective and safe treatment for ZD, particularly among treatment-naïve patients. Comparative studies with other treatment modalities over longer follow-up are warranted.

Advanced achalasia: good candidate for peroral endoscopic myotomy

2020 ◽  
Author(s):  
Shaotian Qiu ◽  
Ningli Chai ◽  
Yaqi Zhai ◽  
Xiangyao Wang ◽  
Yan Wang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Success ◽  
Laparoscopic Heller Myotomy ◽  
Peroral Endoscopic Myotomy ◽  
Symptom Duration ◽  
Technical Success ◽  
Technical Success Rate ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
Favorable Safety

SUMMARY Peroral endoscopic myotomy (POEM) has been increasingly accepted as the first-line treatment of achalasia. However, laparoscopic Heller myotomy or esophagectomy still remains as the mainstay treatment for advanced achalasia featured with megaesophagus and/or sigmoid-shaped esophagus. Although the efficacy of POEM for advanced achalasia with sigmoid-shaped esophagus has been described, little is known about the role of POEM for patients with megaesophagus. The aim of our study is to evaluate the efficacy and safety of POEM for advanced achalasia with megaesophagus. Patients who received initial examinations and underwent POEM in our hospital from June 2013 to December 2018 were identified and data were retrospectively analyzed. The advanced achalasia was defined as megaesophagus with a diameter of ≥6 cm. The primary outcome was clinical success. The secondary outcomes were technical success and adverse events. A total of 112 patients (50 females, 44.6%) were included with a mean age of 44.8 years. The median symptom duration was 6.5 years (IQR:3.0–13.0 years). Modified POEM techniques were used in 27.7% (31/112) of patients. Technical success rate was 99.1% (112/113) per procedure. Clinical success was seen in 93.1% patients with median Eckardt score decreasing from 8.0 to 1.0 (P &lt; 0.001) during a median 31.0 months of follow-up. The mean LES pressure decreased from 29.5 mmHg to 14.2 mmHg after POEM (P &lt; 0.05). Procedure-related adverse events occurred in 8.9% patients. Reflux disease was observed postoperatively in 26.7% of patients. POEM is also indicated for patients with advanced achalasia with a favorable safety and efficacy.

scholarly journals Peroral Endoscopic Myotomy for Esophageal Achalasia in Portugal: Outcomes of the First Prospective Series

2020 ◽  
pp. 1-8
Author(s):  
Rui Mendo ◽  
Pedro Barreiro ◽  
José Rodrigues ◽  
Catarina Félix ◽  
Catarina O&apos;Neill ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Success ◽  
Peroral Endoscopic Myotomy ◽  
Successful Outcome ◽  
Consecutive Series ◽  
Procedure Time ◽  
Short Term ◽  
Invasive Treatment ◽  
Eckardt Score ◽  
Endoscopic Myotomy

<b><i>Background:</i></b> Peroral endoscopic myotomy (POEM) is an innovative achalasia treatment procedure that involves myotomy of the lower esophageal sphincter through a submucosal tunneling approach, combining the efficacy of surgical myotomy with the benefit of being a less invasive treatment. At this time, no data are available of POEM in Portugal. This study aimed to examine the safety and short-term outcomes of POEM in a Portuguese center. <b><i>Methods:</i></b> Fifty POEM were performed on 49 consecutive patients at our institution between January 2017 and January 2020. A prospective study of a consecutive series of patients was conducted, including procedure time, myotomy location and length, adverse events and clinical success. An Eckardt score of ≤3 after POEM was deemed as a successful outcome. Gastroesophageal reflux disease (GERD) was evaluated based on symptoms and on upper endoscopy, which was performed at 3–6 months postoperatively to check for reflux esophagitis. <b><i>Results:</i></b> POEM was successfully completed in all cases: 70% (<i>n</i> = 35) were naïve and 30% (<i>n</i> = 15) had previous treatments. The mean procedure time was 73.4 ± 22.6 min (range 45–125 min). There were no major adverse events. Minor adverse events were rare (8%), and there was no perioperative mortality. The Eckardt score significantly decreased from 6.9 ± 2.4 preoperatively to 0.5 ± 1.0 postoperatively (<i>p</i> &#x3c; 0.05). Overall clinical success was documented in 98, 98 and 95.2% at 1, 3 and 6 months, respectively. These short-term outcomes after POEM were independent of previous treatments. Symptomatic GERD was seen in 22.4% of patients. <b><i>Conclusions:</i></b> Our results confirm the safety and excellent short-term efficacy of POEM in a Portuguese center. This supports POEM as one of the first-line achalasia therapies in Portugal when performed by experienced operators.

scholarly journals Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up

2021 ◽  
Vol 09 (07) ◽  
pp. E1097-E1107
Author(s):  
Andrew Ofosu ◽  
Babu P. Mohan ◽  
Yervant Ichkhanian ◽  
Maen Masadeh ◽  
John Febin ◽  
...  
Keyword(s):  
Clinical Success ◽  
Meta Analysis ◽  
Balloon Dilation ◽  
Final Analysis ◽  
Peroral Endoscopic Myotomy ◽  
Pneumatic Dilation ◽  
Type I ◽  
Eckardt Score ◽  
Endoscopic Myotomy

Abstract Background and study aims Peroral endoscopic myotomy (POEM) is increasingly being used as the preferred treatment option for achalasia. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of POEM versus pneumatic balloon dilation (PD). Methods We performed a comprehensive review of studies that reported clinical outcomes of POEM and PD for the treatment of achalasia. Measured outcomes included clinical success (improvement of symptoms based on a validated scale including an Eckardt score ≤ 3), adverse events, and post-treatment gastroesophageal reflux disease (GERD). Results Sixty-six studies (6268 patients) were included in the final analysis, of which 29 studies (2919 patients) reported on POEM and 33 studies (3050 patients) reported on PD and 4 studies (299 patients) compared POEM versus PD. Clinical success with POEM was superior to PD at 12, 24, and 36 months (92.9 %, vs 76.9 % P = 0.001; 90.6 % vs 74.8 %, P = 0.004; 88.4 % vs 72.2 %, P = 0.006, respectively). POEM was superior to PD in type I, II and III achalasia (92.7 % vs 61 %, P = 0.01; 92.3 % vs 80.3 %, P = 0.01; 92.3 %v 41.9 %, P = 0.01 respectively)Pooled OR of clinical success at 12 and 24 months were significantly higher with POEM (8.97; P = 0.001 & 5.64; P = 0.006). Pooled OR of GERD was significantly higher with POEM (by symptoms: 2.95, P = 0.02 and by endoscopic findings: 6.98, P = 0.001). Rates of esophageal perforation (0.3 % vs 0.6 %, P = 0.8) and significant bleeding (0.4 % vs 0.7 %, P = 0.56) were comparable between POEM and PD groups. Conclusions POEM is more efficacious than PD in the treatment of patients with achalasia during short-term and long-term follow-up, albeit with higher risk of abnormal esophageal acid exposure.

Management of Patients after Failed Peroral Endoscopic Myotomy: a Multicenter Study

Endoscopy ◽  
2020 ◽  
Author(s):  
Yervant Ichkhanian ◽  
Daniella Assis ◽  
Pietro Familiari ◽  
Michael B Ujiki ◽  
Baily Su ◽  
...  
Keyword(s):  
Clinical Success ◽  
Management Strategies ◽  
Laparoscopic Heller Myotomy ◽  
Peroral Endoscopic Myotomy ◽  
Pneumatic Dilation ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
Excellent Safety Profile ◽  
International Multicenter

Background and Aims: Although Peroral Endoscopic Myotomy (POEM) is highly effective for the management of achalasia, clinical failures may occur. The optimal management of patients who fail POEM is not well known. This study aims to compare the outcomes of different management strategies in patients who had failed POEM. Patients and Methods: This is an international, multicenter, retrospective study at 16 tertiary centers between 1/2012 and 11/2019. All patients who underwent POEM and experienced persistent or recurrent symptoms (Eckardt score (ES) > 3) were included. The primary outcome was to compare the rate of clinical success (ES ≤ 3) between different management strategies. Results: A total of 99 patients (50 (50.5%) males, mean age 51.4 (16.2) yrs.) experienced clinical failure during the study period with a mean ES of 5.5 (0.2). A total of 29 (32.2%) patients were managed conservatively and 70 (71%) underwent re-treatment [repeat POEM 33 (33%), pneumatic dilation (PD) 30 (30%), and laparoscopic Heller myotomy (LHM) 7 (7.1%)]. During a median follow-up of 10 (IQR: 3-20) months, clinical success was highest in patients who underwent repeat POEM (25/33 (76%), mean ES 2.1 (2.1)), followed by PD (18/30 (60%), mean ES 2.8 (2.3)), and LHM (2/7 (29%), 4 (1.8)) (p=0.12). A total of 11 (37.9%, mean ES 4 (1.8)) patients in the conservative achieved clinical success. Conclusion: This study comprehensively assessed an international cohort of patients who underwent management of failed POEM. Repeat POEM and PD achieved acceptable clinical success with excellent safety profile.

The Effect of Peroral Endoscopic Myotomy in Achalasia Patients with Prior Endoscopic Intervention: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-13
Author(s):  
Chunyu Zhong ◽  
Bowen Ni ◽  
Sixiu Liu ◽  
Shali Tan ◽  
Muhan Lü ◽  
...  
Keyword(s):  
Adverse Events ◽  
Randomized Clinical Trials ◽  
Clinical Success ◽  
Meta Analysis ◽  
Clinical Success Rate ◽  
Peroral Endoscopic Myotomy ◽  
Technical Success ◽  
Endoscopic Intervention ◽  
Eckardt Score ◽  
Endoscopic Myotomy

<b><i>Background:</i></b> Peroral endoscopic myotomy (POEM) has been reported to be effective in achalasia patients with prior failed endoscopic intervention (PFI). We performed this meta-analysis to compare and summarize the clinical outcome of POEM in patients with or without prior endoscopic intervention. <b><i>Method:</i></b> We searched relevant studies published up to March 2020. Meta-analysis for technical success, clinical success, Eckardt score, lower esophageal sphincter (LES) pressure, clinical reflux, and adverse event were conducted based on a random-effects model. <b><i>Results:</i></b> Eight studies enrolling 1,797 patients who underwent POEM were enrolled, including 1,128 naïve achalasia patients and 669 patients with PFI. In the PFI group, the pooled estimated rate of technical success was 97.7% (95% confidence interval [CI], 95.8–98.8%), the pooled clinical success rate was 91.0% (95% CI, 88.0–93.4%), and the pooled adverse events rate was 23.5% (95% CI, 10.6–44.1%). The Eckardt score significantly decreased by 5.95 points (95% CI, 5.50–6.40, <i>p</i> &#x3c; 0.00001) and the LES pressure significantly reduced by 19.74 mm Hg (95% CI, 14.10–25.39, <i>p</i> &#x3c; 0.00001) in the PFI group. There were no difference in the technical success, clinical success, and adverse events rate between the treatment-naïve group and PFI group, with a risk ratio of 1.0 (95% CI, 0.99–1.01, <i>p</i> = 0.89), 1.02 (95% CI, 0.98–1.06, <i>p</i> = 0.36), and 0.88 (95% CI, 0.67–1.16, <i>p</i> = 0.38), respectively. <b><i>Conclusions:</i></b> POEM is an effective and safe treatment for achalasia patients with prior endoscopic intervention. Randomized clinical trials are needed to further verify the efficiency and safety of the POEM in those patients.

scholarly journals Role of peroral endoscopic myotomy in geriatric patients with achalasia: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Chunyu Zhong ◽  
Sixiu Liu ◽  
Huifang Xia ◽  
Shali Tan ◽  
Muhan Lü ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Geriatric Patients ◽  
Clinical Success ◽  
Meta Analysis ◽  
Peroral Endoscopic Myotomy ◽  
Cochrane Library ◽  
Eckardt Score ◽  
Endoscopic Myotomy

Background: Peroral endoscopic myotomy (POEM) is a particularly attractive intervention for achalasia. Presently, POEM has been reported to be effective and safe for achalasia in geriatric patients. Herein, this systematic review was conducted to explore the role of POEM in geriatric patients with achalasia. Method: PubMed, Embase and Cochrane Library were searched to identify studies evaluating the clinical outcome of POEM in geriatric patients with achalasia during January 2009 to October 2020. The primary outcomes were technical and clinical success. Secondary outcomes included postoperative Eckardt score, lower esophageal sphincter (LES) pressure, adverse events and clinical reflux. Results: There were seven studies with a total of 469 geriatric patients, pooled technical success of POEM treatment was 98.1% [95% confidence interval (CI), 95.1%-99.3%], and the pooled clinical success was 92.5% (95% CI, 89.3%-94.8%). After POEM, the Eckardt score significantly decreased by 6.09 points (95% CI, 5.44-6.74, P<0.00001), and the LES pressure significantly reduced by 13.53 mmHg (95% CI, 5.14-21.91, P=0.002). The pooled adverse events rate was 9.0% (95% CI, 4.3%-17.9%) and the post-POEM clinical reflux rate was 17.4% (95% CI, 12.9%-23.2%). Conclusions: Our current study demonstrated that POEM was an effective and safe technique for achalasia in geriatric patients.

scholarly journals Feasibility of Using an Led-Probe in Third-Space Endoscopy: A Clinical Study

2020 ◽  
Author(s):  
Oscar Victor Hernández Mondragón ◽  
Raul Antonio Zamarripa Mottu ◽  
Omar Michell Solórzano Pineda ◽  
Raul Antonio Gutierrez Aguilar ◽  
Luis Fernando Garcia Contreras
Keyword(s):  
Clinical Success ◽  
Care Center ◽  
Tertiary Care ◽  
Third Space ◽  
Peroral Endoscopic Myotomy ◽  
Gastric Emptying Scintigraphy ◽  
Submucosal Tunnel ◽  
Average Patient ◽  
Endoscopic Myotomy ◽  
Integrated Relaxation Pressure

Abstract Background and aims: Third-space endoscopy is a novel, safe, and effective method for treating different gastrointestinal conditions. However, several failed endoscopic procedures are attributed to incomplete myotomy. Lighting devices are used to prevent organic injuries. We aimed to investigate the feasibility of using a hand-made LED-probe (LP) in third-space procedures.Patients and Methods: This prospective study was conducted in a tertiary-care center in Mexico between December 2016 and January 2019. We included peroral endoscopic myotomy (POEM) and gastric peroral endoscopic myotomy(G-POEM) procedures. Pseudoachalasia, peptic ulcer, normal gastric emptying scintigraphy (GES) and prepyloric tumors were excluded. LP was used to guide or confirm procedures. Clinical and procedural characteristics were recorded and analyzed.Results: Seventy third-space procedures were included (42POEM,28G-POEM), with an average patient age of 46.7±14.3 and 43.7±10.1 years, respectively. For the POEM and G-POEM groups, respectively, 18/42(42.9%) and 13/28(46.7%) patients were males; median procedure times were 50 (interquartile range[IQR]: 38-71) and 60(IQR: 48-77) min, median LP placement times were 5(IQR: 4-6) and 6(IQR: 5-7) min, mild adverse events occurred in 4(9.4%) and 4(14.2%) of cases, and clinical success at 6 months occurred in 100% and 85.7% of cases. Integrated relaxation pressure (IRP) improved from 27.3±10.8 to 9.5±4.1 mmHg (p<0.001); retention percentage at 4 hours also improved. LP was successfully placed and adequate myotomy confirmed including 14.2% and 17.8% of POEM and G-POEM difficult patients. Conclusions: Using an LP is promising and allows guiding during third-space procedures either for submucosal tunnel creation or myotomy confirmation, with excellent safety and efficacy in clinical practice.

Safety and efficacy of submucosal tunneling endoscopic septum division for epiphrenic diverticula

Endoscopy ◽  
2019 ◽  
Vol 51 (12) ◽  
pp. 1141-1145 ◽  
Author(s):  
Xuan Li ◽  
Weifeng Zhang ◽  
Juliana Yang ◽  
Xiaoyong Wang ◽  
Yini Dang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Length Of Hospital Stay ◽  
Median Number ◽  
Procedure Time ◽  
Safety And Efficacy ◽  
Submucosal Tunnel ◽  
Eckardt Score ◽  
Total Procedure Time ◽  
Epiphrenic Diverticula ◽  
The Mean

Abstract Background Symptomatic epiphrenic diverticula are mostly treated with laparoscopic diverticulectomy. Our study aimed to demonstrate the safety and efficacy of submucosal tunneling endoscopic septum division (STESD) for treatment of symptomatic epiphrenic diverticula. Methods Data from patients with epiphrenic diverticula who had undergone STESD were retrospectively reviewed. The parameters analyzed were the modified Eckardt score, total procedure time, length of hospital stay (LOS), number of clips used, adverse events, and patient satisfaction. Results A total of eight patients (5 men; mean [standard deviation (SD)] age 66.25 [7.17] years) were enrolled in our study. The mean (SD) size of epiphrenic diverticula was 3.68 (1.59) cm. The mean (SD) procedure time was 52.87 (22.47) minutes, with a median number of six clips being applied. The modified Eckardt score significantly decreased post-procedure (P < 0.001). The mean (SD) LOS was 5.87 (0.83) days. No adverse events or symptom recurrences were reported. Conclusion STESD is a safe and effective technique to be performed in the submucosal tunnel for the management of patients with epiphrenic diverticula.

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