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.

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.

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.

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

scholarly journals Combined lenvatinib and pembrolizumab as salvage therapy in advanced adrenal cortical carcinoma

2020 ◽  
Vol 8 (2) ◽  
pp. e001009
Author(s):  
Sara Bedrose ◽  
Kevin Charles Miller ◽  
Lina Altameemi ◽  
Mohamed S Ali ◽  
Sameh Nassar ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Salvage Therapy ◽  
Checkpoint Inhibitors ◽  
Single Agent ◽  
Case Series ◽  
Progression Free Survival ◽  
Adrenal Cortical Carcinoma ◽  
Retrospective Case ◽  
First Case ◽  
Platinum Based Chemotherapy

BackgroundThere is no effective systemic therapy for metastatic adrenal cortical carcinoma (ACC) after failure of platinum-based chemotherapy. The efficacies of single-agent oral multikinase inhibitors (MKIs) or salvage immune checkpoint inhibitors (CPIs) have been very limited. It is unknown whether combining CPIs, such as pembrolizumab (PEM), with other therapies, such as MKIs, could yield higher response rates in ACC, yet this combination has shown promise in other cancers. Herein, we describe the first case series using PEM in combination with the MKI lenvatinib (LEN) in patients with progressive, metastatic ACC.MethodsA retrospective case series describing the use of LEN/PEM as salvage therapy in patients with progressive/metastatic ACC.ResultsEight patients were treated with the LEN/PEM combination therapy. Half were female, and the median age at time of diagnosis was 38 years (range 21–49). Three (37.5%) patients had hormonally active ACC. The median number of prior lines of systemic therapy was 4 (range 2–9). Six (75%) patients had had disease progression on prior CPIs and five (62.5%) patients had progressed on prior MKI therapy. The median progression-free survival was 5.5 months (95% CI 1.8–not reached) and median duration of therapy was 8.5 months (range 2–22). Two (25%) patients had a partial response, one (12.5%) patient had stable disease, and five (62.5%) patients had progressive disease. None of the eight patients stopped therapy because of adverse events.ConclusionsIn our small cohort of heavily pretreated patients with ACC, the combination of LEN/PEM was associated with objective responses in a subset of patients without significant toxicity. This combination should be formally investigated in phase II clinical trial with robust correlative studies to identify predictors for response.

Extra-articular Medial Impression Fracture of the Talus: A Previously Undescribed Injury

2018 ◽  
Vol 11 (6) ◽  
pp. 553-558
Author(s):  
Olivier Wijers ◽  
Rosa C. Looijen ◽  
Jens A. Halm ◽  
Tim Schepers
Keyword(s):  
Correct Diagnosis ◽  
Case Series ◽  
Patient Characteristics ◽  
Trauma Mechanism ◽  
Retrospective Case ◽  
Articular Fractures ◽  
First Case ◽  
Impression Fracture ◽  
Talar Fractures ◽  
Almost All

Background: Peripheral fractures of the talus are uncommon. Almost all the literature regarding talar fractures consists of central intra-articular fractures, whereas studies about peripheral talar fractures are lacking. The aim of this study is to increase awareness in diagnosing an unusual peripheral extra-articular medial impression fracture of the talus. Methods: This study includes a retrospective case series of patients with an extra-articular medial impression fracture of the talus. Patient characteristics, trauma mechanism, diagnostics, fracture characteristics, and treatment were reported. Results: Eight consecutive patients with an extra-articular medial impression fracture of the talus were identified. In 80%, the trauma mechanism was a supination or inversion injury of the ankle and foot. An X-ray was obtained in all patients; in 7 (88%) patients, a computed tomography scan was done, and an additional magnetic resonance imaging was done in 3 (38%) patients. In 4 patients (50%), the correct diagnosis was missed at first presentation. The delay between injury and diagnosis was 0 to 180 days (of 36 days on average). Conclusion: This is the first case series to describe patients with a peripheral extra-articular medial impression fracture of the talus. Good clinical examination and judicious use of diagnostic imaging are a necessity to find the talar impression fractures in a timely manner, and treatment can be started immediately. Levels of Evidence: Level V

scholarly journals Clinical Features and Outcomes of Patients with Elizabethkingia Meningoseptica Infection: An Emerging Pathogen

2020 ◽  
Author(s):  
Abdullah Umair ◽  
Nosheen Nasir
Keyword(s):  
Hospital Stay ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Opportunistic Pathogen ◽  
University Hospital ◽  
Retrospective Case ◽  
First Case ◽  
Elizabethkingia Meningoseptica ◽  
Co Morbidity ◽  
Morbidity Index

Abstract Background:Elizabethkingia meningoseptica, formerly known as Chryseobacterium meningosepticum, is a non-motile, non-fastidious, catalase and oxidase-positive, aerobic, glucose-non-fermentative Gram-negative bacillus first defined by Elizabeth O. King in 1959. It has recently emerged as an opportunistic pathogen infecting people in the the extremes of age and the immunocompromised, especially in nosocomial settings. There has been an increased interest in this pathogen due to its rising occurrence around the world, its ubiquity in nature, and inherent capacity for antimicrobial resistance.Methods: We describe a retrospective case series at the Aga Khan University Hospital in Karachi, Pakistan on patients admitted from January 2013 to December 2018 with Elizabethkingia meningoseptica infections. All patients identified to have any clinical culture specimen positive for Elizabethkingia meningoseptica were included. Data was collected on a structured proforma from the Hospital Information Management Systems (HIMS).Results:Sixteen patients with E. meningoseptica were identified. The mean Charlson’s co-morbidity index was 3.25. Nine patients had bacteremia with E. meningosepticum. Three of the isolates were extensively drug resistant with sensitivity only to minocycline. Nine out of 16 patients required intubation and mechanical ventilation. The median length of hospital stay was 13 days and four out of 16 patients died during hospital stay,Conclusion: This is the first case series from Pakistan reporting Elizabethkingia meningoseptica infections.

scholarly journals Advances in the diagnosis and treatment of achalasia of the cardia: A review

2021 ◽  
Vol 9 (1) ◽  
pp. 24-31
Author(s):  
Baozhen Zhang ◽  
Yidan Wang ◽  
Ye Liao ◽  
Jingjing Zhang ◽  
Yufan Wu ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Peroral Endoscopic Myotomy ◽  
Diagnosis And Treatment ◽  
Pneumatic Dilation ◽  
Motor Disorder ◽  
Sphincter Pressure ◽  
Idiopathic Achalasia ◽  
Retrosternal Pain ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Abstract Idiopathic achalasia is an esophageal motor disorder characterized by the loss of the lower esophageal sphincter ganglion, resulting in impaired lower esophageal relaxation and absence of esophageal peristalsis. Patients commonly present with progressive dysphagia accompanied by reflux, heartburn, retrosternal pain, and severe weight loss. Diagnosis is primarily based on the patient’s chief complaints, barium esophagography, and the most recent high-resolution manometry. Endoscopic assessment and endoscopic ultrasonography also have significant value with regard to the exclusion of esophageal anatomical lesions, neoplastic diseases, and pseudoachalasia. However, as most patients with achalasia demonstrate a gradual onset, early diagnosis is difficult. Currently, treatment of idiopathic achalasia, including pneumatic dilation, stent placement, and surgical myotomy, is aimed at reducing lower esophageal sphincter pressure and relieving the symptoms of dysphagia. Peroral endoscopic myotomy has gradually become the mainstream treatment because it causes less trauma and has a rapid recovery rate. This article reviews the main methods of diagnosis and treatment of achalasia, with an emphasis on the potential of peroral endoscopic myotomy and the advancements of immunotherapy for achalasia.

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