An international study on the use of peroral endoscopic myotomy (POEM) in the management of esophageal diverticula: the first multicenter D-POEM experience

Endoscopy ◽  
2018 ◽  
Vol 51 (04) ◽  
pp. 346-349 ◽  
Author(s):  
Juliana Yang ◽  
Xianhui Zeng ◽  
Xianglei Yuan ◽  
Kenneth Chang ◽  
Omid Sanaei ◽  
...  
Keyword(s):  
Clinical Success ◽  
Case Series ◽  
Peroral Endoscopic Myotomy ◽  
Endoscopic Management ◽  
Distinct Advantage ◽  
Technical Success Rate ◽  
Dysphagia Score ◽  
Esophageal Diverticula ◽  
First Case ◽  
Endoscopic Myotomy

Abstract Background The aim of this study is to report a novel, multicenter experience with the diverticular peroral endoscopic myotomy (D-POEM) technique in the management of esophageal diverticula. Methods This is a multicenter, international, retrospective study involving three centers. D-POEM was performed using the principles of submucosal endoscopy. Results A total of 11 patients with an esophageal diverticulum (Zenker’s 7, mid-esophagus 1, epiphrenic 3) were included. The mean size of the esophageal diverticula was 34.5 mm. The overall technical success rate of D-POEM was 90.9 %, with a mean procedure time of 63.2 minutes. There were no adverse events. Clinical success was achieved in 100 % (10 /10), with a decrease in mean dysphagia score from 2.7 to 0.1 (P < 0.001) during a median follow-up of 145 days (interquartile range 126 – 273). Conclusion Endoscopic management of esophageal diverticula using the novel technique of D-POEM appears promising. This first case series on D-POEM suggests that the procedure is feasible, safe, and effective in the management of esophageal diverticula. D-POEM offers the distinct advantage of ensuring a complete septotomy. Larger studies are needed to confirm these intriguing results.

Peroral endoscopic myotomy (POEM) for dysphagia and esophageal motor disorder after antireflux fundoplication

Endoscopy ◽  
2020 ◽  
Vol 52 (07) ◽  
pp. 583-588
Author(s):  
Jean-Michel Gonzalez ◽  
Laurent Monino ◽  
Philippe Ah-Soune ◽  
Véronique Vitton ◽  
Marc Barthet
Keyword(s):  
Clinical Efficacy ◽  
Laparoscopic Fundoplication ◽  
Therapeutic Option ◽  
Case Series ◽  
Peroral Endoscopic Myotomy ◽  
Efficacy Rate ◽  
Motor Disorder ◽  
Retrospective Case ◽  
First Case ◽  
Endoscopic Myotomy

Abstract Introduction Laparoscopic fundoplication is the treatment of severe and refractory gastroesophageal reflux disease (GERD). It induces dysphagia in 5 % – 10 % owing to a tight valve ± esophageal motility disorders (EMD), with challenging management. We assessed the first case series assessing peroral endoscopic myotomy (POEM) in such a situation. Methods A retrospective case series including eight patients with severe dysphagia after laparoscopic fundoplication who were treated by POEM. They were assessed clinically by Eckardt and Mellow – Pinkas dysphagia scores, and by high resolution manometry (HRM). The procedure was a regular esophageal POEM, mainly posterior, including a myotomy of the wrap. The objectives were to evaluate the clinical efficacy, technical difficulties, and complications of this approach. Results HRM showed aperistalsis in 6 /8 patients and raised lower esophageal sphincter (LES) pressure in 5 /8. The median preoperative Eckardt and dysphagia scores were 5 and 3.5, respectively. The procedure was completed in 7 /8 patients, with a clinical efficacy rate (normalization of both scores) of 75 % (6 /8). Although the submucosa seemed more fibrotic and vascularized, no severe complications occurred. Conclusion POEM is a newly described therapeutic option to consider for managing dysphagia due to EMD after laparoscopic fundoplication.

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.

Impact of prior treatment on feasibility and outcomes of Zenker’s peroral endoscopic myotomy (Z-POEM)

Endoscopy ◽  
2020 ◽  
Author(s):  
Omid Sanaei ◽  
Yervant Ichkhanian ◽  
Oscar V. Hernández Mondragón ◽  
Jose Nieto ◽  
Arunkumar Krishnan ◽  
...  
Keyword(s):  
Complete Resolution ◽  
Primary Outcome ◽  
Surgical Intervention ◽  
Clinical Success ◽  
Peroral Endoscopic Myotomy ◽  
Zenker’S Diverticulum ◽  
Dysphagia Score ◽  
Zenker's Diverticulum ◽  
Endoscopic Myotomy

Abstract Background Zenker’s peroral endoscopic myotomy (Z-POEM) is a novel procedure for the management of symptomatic Zenker’s diverticulum. This study aims to report the technical feasibility and outcomes of Z-POEM in the management of Zenker’s diverticulum after prior failed interventions. Methods Patients with persistent or recurrent symptoms after prior endoscopic and/or surgical intervention for Zenker’s diverticulum were retrospectively included. The primary outcome was clinical success, defined as complete or near complete resolution of dysphagia (dysphagia score of 0 or 1) without the need for repeat endoscopic or surgical intervention during follow-up. Results Z-POEM was technically successful in 30/32 patients (93.8 %). Clinical success was achieved in 29/30 patients (96.7 %), and Z-POEM significantly reduced the median (interquartile range [IQR]) dysphagia score of patients from 2 (1 – 2) to 0 (0) (P < 0.001) over a median duration of follow up of 166 days (IQR 39 – 566). Four patients (12.5 %) had adverse events (two inadvertent mucosotomies and two leaks found on post-procedural esophagrams). Conclusion Z-POEM is feasible, safe, and effective in the majority of patients with recurrent symptoms after prior surgical or endoscopic interventions.

scholarly journals Z-POEM as a Treatment Option for Zenker’s Diverticulum: Our Experience at a Tertiary Care Centre in India

2020 ◽  
Vol 11 (03) ◽  
pp. 209-214
Author(s):  
Pankaj N. Desai ◽  
Mayank V. Kabrawala ◽  
Chintan N. Patel ◽  
Rajiv M. Mehta ◽  
Subhash K. Nandwani ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Endoscopic Management ◽  
Zenker’S Diverticulum ◽  
Efficacy And Safety ◽  
Technical Success Rate ◽  
Dysphagia Score ◽  
Zenker's Diverticulum ◽  
Endoscopic Myotomy ◽  
The Mean

Abstract Background This study was aimed to evaluate efficacy and safety of Z–peroral endoscopic myotomy (Z-POEM; submucosal tunneling endoscopic myotomy) for Zenker’s diverticulum (ZD). Methods This is a retrospective study at a single tertiary care center in India. The Z-POEM technique was performed using principles of submucosal tunneling endoscopy with prior experience from POEM technique for achalasia cardia Results Sixteen patients (male, 62.5%; mean age, 73.2 ± 5.2 years) were included with a mean Charleson’s comorbidity index of 4.32. The mean size of ZD was 34.8 ± 10.0 mm. The technical success rate was 100%. Clinical success was achieved in 100% (16/16) with a decrease in mean dysphagia score from 2.9 to 0.2 (p <0.0001). The mean procedure time was 47 ± 7.9 minutes and mean length of septotomy was 31.9 ± 9.4 mm. The mean length of hospital stay was 1.2 ± 0.4 days. No major adverse events were noted. Capnomediastinum was noted in two cases on follow-up Gastrografin study after 24 hours (12.5%). This did not merit any treatment. One patient had intraprocedural bleed which was controlled easily. At the 18-month follow-up, two (12.5%) patients reported dysphagia recurrence (Dakkak and Bennett score 1) but did not require repeat intervention. Conclusion Endoscopic management of ZD using the POEM technique is a promising technique with improved efficacy and safety. However, long-term follow-up is needed to ensure the durability of response.

scholarly journals Transoral Incisionless fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal

2018 ◽  
Vol 06 (05) ◽  
pp. E549-E552 ◽  
Author(s):  
Amy Tyberg ◽  
Anthony Choi ◽  
Monica Gaidhane ◽  
Michel Kahaleh
Keyword(s):  
Adverse Events ◽  
Case Series ◽  
Acid Exposure ◽  
Peroral Endoscopic Myotomy ◽  
Technical Success ◽  
Post Procedure ◽  
First Case ◽  
Endoscopic Myotomy ◽  
Small Cohort

Abstract Introduction Increased esophageal acid exposure is seen in a large percentage of patients with achalasia who undergo peroral endoscopic myotomy (POEM). Endoscopic transoral fundoplication (TIF) is a novel endoscopic technique for the management of patients with chronic gastroesophageal reflux (GERD). We present the first case series evaluating the role of TIF post-POEM. Methods Consecutive patients 18 years or older from our academic institution who underwent a POEM procedure and subsequently underwent TIF for symptomatic reflux or regurgitation between December 2014 and June 2017 were included. The primary outcome was discontinuation of proton-pump inhibitor (PPI) use and healing of esophagitis (when initially present) on post-procedure esophagogastroduodenoscopy (EGD). Technical success was defined as successful completion of the endoscopic fundoplication. Adverse events (AEs) were recorded for all patients. Results Five patients were included (60 % male, average age 55 ± 14 years). Technical success was achieved in 100 % of patients. Discontinuation of PPI use was achieved in 5/5 patients (100 %). Three patients had esophagitis pre-procedure and all were noted to have resolution of inflammation on post-procedure EGD. No adverse events were noted. Mean follow-up time was 27 months (range 5 – 34 months). Conclusion TIF post-POEM appears feasible, safe, and efficacious in improving symptoms and esophagitis, decreasing long-term risks of acid exposure, and decreasing risks of long-term PPI use in patients post-POEM in this small cohort of patients. Larger studies are needed to confirm these initial findings.

Peroral endoscopic myotomy for management of cricopharyngeal bars (CP-POEM): a retrospective evaluation

Endoscopy ◽  
2021 ◽  
Author(s):  
Sarah S. Al Ghamdi ◽  
Michael Bejjani ◽  
Oscar V. Hernández Mondragón ◽  
Nasim Parsa ◽  
Muhammad N. Yousaf ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Success ◽  
Peroral Endoscopic Myotomy ◽  
Technical Success ◽  
Long Term Outcome ◽  
Dysphagia Score ◽  
Presenting Symptoms ◽  
Endoscopic Myotomy ◽  
Symptom Recurrence

Abstract Background Cricopharyngeal bars (CPBs) are a unique etiology of oropharyngeal dysphagia. Symptomatic patients are managed with endoscopic dilation or surgical myotomy. Cricopharyngeal peroral endoscopic myotomy (CP-POEM) is an emerging technique for the management of dysphagia due to CPBs. This study evaluated technical success, clinical success, adverse events, and long-term recurrence following CP-POEM. Methods Consecutive patients who underwent POEM for management of CPBs between May 2015 and December 2020 at four tertiary care centers were included. Primary outcome was clinical success (defined as improvement of dysphagia score to ≤ 1). Secondary outcomes were technical success, rate and severity of adverse events, procedure duration, and symptom recurrence. Results 27 patients (mean age 69 years; 10 female) underwent CP-POEM during the study period. The most common presenting symptoms at the time of index procedure were dysphagia (26; 96.3 %) and regurgitation (20; 74.1 %). Clinical and technical success were achieved in all patients. Mild/moderate adverse events occurred in two patients (7.4 %). CP-POEM significantly reduced the median dysphagia score. Conclusions CP-POEM was a safe and effective treatment for symptomatic CPBs. Although symptom recurrence was low, long-term outcome data are needed. CP-POEM should be considered as a management option for symptomatic CPBs at centers with POEM expertise.

Operative technical tricks and 12-month outcomes of diverticular peroral endoscopic myotomy (D-POEM) in patients with symptomatic esophageal diverticula

Endoscopy ◽  
2019 ◽  
Vol 51 (12) ◽  
pp. 1136-1140 ◽  
Author(s):  
Amit Maydeo ◽  
Gaurav K. Patil ◽  
Ankit Dalal
Keyword(s):  
Clinical Success ◽  
Peroral Endoscopic Myotomy ◽  
Symptom Duration ◽  
Epiphrenic Diverticulum ◽  
Multicenter Studies ◽  
Eckardt Score ◽  
Esophageal Diverticula ◽  
Body Sensation ◽  
Endoscopic Myotomy

Abstract Background Submucosal tunneling diverticular septotomy by diverticular peroral endoscopic myotomy (D-POEM) has emerged as an alternative to surgery for symptomatic esophageal diverticula, but its medium to long-term outcomes are currently unexplored. Methods D-POEM for patients with symptomatic esophageal diverticula was prospectively studied to assess its safety and the 12-month outcomes. Results 25 patients (72 % male; median age 61 years [range 48 – 88]) with a Zenker’s diverticulum (n = 20) or epiphrenic diverticulum (n = 5) were included. Major indications were dysphagia, recurrent bronchoaspiration, and foreign body sensation in 20 patients (80 %), with a mean symptom duration of 2.5 years (range 1 – 4). Complete submucosal tunneling septotomy was achieved in a mean of 36 minutes (range 25 – 45), with 100 % technical success. The median hospitalization was 5 days (range 4 – 10). The mean (standard deviation) Eckardt Score improved significantly from 13.2 (1.0) at baseline to 3.2 (1.4) at 12 months (P < 0.001) with clinical success in 19/22 patients (86 %) and no long-term adverse events. Conclusions D-POEM appears safe and durable in patients with esophageal diverticula. Further multicenter studies with a larger patient cohort are warranted.

scholarly journals Anesthetic management and associated complications of peroral endoscopic myotomy: A case series

2018 ◽  
Vol 10 (9) ◽  
pp. 193-199 ◽  
Author(s):  
Yuuki Nishihara ◽  
Takuya Yoshida ◽  
Mayu Ooi ◽  
Norihiko Obata ◽  
Shinichiro Izuta ◽  
...  
Keyword(s):  
Anesthetic Management ◽  
Case Series ◽  
Peroral Endoscopic Myotomy ◽  
Endoscopic Myotomy

One-year results of gastric peroral endoscopic myotomy for refractory gastroparesis: a French multicenter study

Endoscopy ◽  
2020 ◽  
Author(s):  
Olivier Ragi ◽  
Jérémie Jacques ◽  
Julien Branche ◽  
Sarah Leblanc ◽  
Geoffroy Vanbiervliet ◽  
...  
Keyword(s):  
Success Rate ◽  
Multicenter Study ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Peroral Endoscopic Myotomy ◽  
Gastric Retention ◽  
Endoscopic Myotomy ◽  
Cardinal Symptom

Abstract Background: Data on the long-term outcomes of gastric peroral endoscopic myotomy (G-POEM) for refractory gastroparesis are lacking. We report the results of a large multicenter long-term follow-up study of G-POEM for refractory gastroparesis. Methods: This was a retrospective multicenter study of all G-POEM operations performed in seven expert French centers for refractory gastroparesis with at least 1 year of follow-up. The primary endpoint was the 1-year clinical success rate, defined as at least a 1-point improvement in the Gastroparesis Cardinal Symptom Index (GCSI). Results: 76 patients were included (60.5 % women; age 56 years). The median symptom duration was 48 months. The median gastric retention at 4 hours (H4) before G-POEM was 45 % (interquartile range [IQR] 29 % – 67 %). The median GCSI before G-POEM was 3.6 (IQR 2.8 – 4.0). Clinical success was achieved in 65.8 % of the patients at 1 year, with a median rate of reduction in the GCSI score of 41 %. In logistic regression analysis, only a high preoperative GCSI satiety subscale score was predictive of clinical success (odds ratio [OR] 3.41, 95 % confidence interval [CI] 1.01 – 11.54; P = 0.048), while a high rate of gastric retention at H4 was significantly associated with clinical failure (OR 0.97, 95 %CI 0.95 – 1.00; P = 0.03). Conclusions: The results confirm the efficacy of G-POEM for the treatment of refractory gastroparesis, as evidenced by a 65.8 % clinical success rate at 1 year. Although G-POEM is promising, prospective sham-controlled trials are urgently needed to confirm its efficacy and identify the patient populations who will benefit most from this procedure.

scholarly journals Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial

2020 ◽  
Vol 08 (09) ◽  
pp. E1137-E1143
Author(s):  
Yervant Ichkhanian ◽  
Omid Sanaei ◽  
Andrew Canakis ◽  
Kia Vosoughi ◽  
Erik Almazan ◽  
...  
Keyword(s):  
Esophagogastric Junction ◽  
Clinical Success ◽  
Short Form ◽  
Tertiary Care ◽  
Prospective Trial ◽  
Peroral Endoscopic Myotomy ◽  
Outflow Obstruction ◽  
Impedance Planimetry ◽  
Sf 36 ◽  
Endoscopic Myotomy

Abstract Background and study aims Esophagogastric junction outflow obstruction (EGJOO) is a rare esophageal dysmotility disease that is characterized by elevated integrated relaxation pressuse (IRP) with evidence of preserved peristalsis. The role of peroral endoscopic myotomy (POEM) in management of EGJOO is currently unknown. Patients and methods This is a prospective trial conducted in a single US tertiary care center from June 2015 to June 2019. Symptomatic patients, diagnosed with EGJOO on both HRM and endoluminal functional lumen imaging probe (EndoFLIP), who were eligible for POEM were recruited. Primary outcome was clinical success, defined as Eckardt score (ES) ≤ 3, at 6 months post-POEM. Other outcomes included dysphagia score, quality of life as measured by 36-item Short Form health survey scales (SF-36), post-POEM HRM, EndoFLIP, and pH measurements, and adverse events. Results A total of 15 patients (51.8 yr. 9 F) with EGJOO underwent POEM. Pre-POEM mean IRP on HRM and Distensibility index (DI) on EndoFLIP were 24.3 ± 2.2 mmHg and 1.1 ± 0.6 mm2/mmHg, respectively. Clinical success was achieved in 93 % at 6 months post-POEM. There was significant decrease in IRP (-17.6 mmHg) post-POEM. There was significant improvement at 6 months in two of the SF-36 subscales. Ten patients underwent post-POEM pH testing, seven of whom had abnormal DeMeester score. Seven patients underwent EGD evaluation revealing esophagitis in five (2 Los Angeles grade A and 3 grade B). Conclusions POEM offers a high clinical success rate for patients with EGJOO confirmed by impedance planimetry.

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