scholarly journals Outcomes of anterior versus posterior peroral endoscopic myotomy 2 years post-procedure: prospective follow-up results from a randomized clinical trial

Endoscopy ◽  
2020 ◽  
Author(s):  
Yervant Ichkhanian ◽  
Jad P. Abimansour ◽  
Mathieu Pioche ◽  
Kia Vosoughi ◽  
Nicholas Eleftheriadis ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Posterior Approach ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Peroral Endoscopic Myotomy ◽  
Primary Treatment Modality ◽  
Posterior Group ◽  
Endoscopic Myotomy

Abstract Background Peroral endoscopic myotomy (POEM) is considered a primary treatment modality for achalasia. It can be performed using either the anterior or posterior approach. A previous randomized clinical trial (RCT) showed that the posterior approach was noninferior to the anterior approach at 1 year post-POEM in terms of clinical success, rate of adverse event, and risk of gastroesophageal reflux disease (GERD). The aim of this post-RCT study was to compare outcomes at ≥ 2 years post-POEM. Methods Patients who previously completed the 1-year follow-up were contacted and their Eckardt, dysphagia, and GERD questionnaire (GERDQ) scores and frequency of proton pump inhibitor use were recorded. Clinical success was defined as an Eckardt score < 3. Results 150 patients were initially randomized and 138 completed the 1-year follow-up. Of the 138, 111 (anterior group 54, posterior group 57) also completed ≥ 2 years of follow-up, with an overall clinical success decrease from 89 % to 82 %. At ≥ 2 years post-POEM, clinical success was achieved in 46/54 (85 %) and 45/57 (79 %) in the anterior and posterior groups, respectively (P = 0.43). A similar decrease in clinical success was noted in both groups at ≥ 2 years (anterior: 90 % to 85 %; posterior 89 % to 79 %; P = 0.47). GERDQ score was 6 (interquartile range 6 – 8; P = 0.08) in both treatment groups. Conclusions The anterior and posterior POEM techniques remained equally effective at 2 years and decreases in efficacy were similar between the two approaches over time. GERD outcomes were also similar in both groups during medium-term follow-up.

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.

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 (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.

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 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.

scholarly journals 837 PERORAL ENDOSCOPIC MYOTOMY (POEM): ANTERIOR VERSUS POSTERIOR APPROACH, A RANDOMIZED SINGLE-BLINDED CLINICAL TRIAL

2018 ◽  
Vol 87 (6) ◽  
pp. AB119 ◽  
Author(s):  
Mouen A. Khashab ◽  
Omid Sanaei ◽  
Thierry Ponchon ◽  
Nicholas Eleftheriadis ◽  
Philip Wai Yan W. Chiu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Posterior Approach ◽  
Peroral Endoscopic Myotomy ◽  
Endoscopic Myotomy

Peroral endoscopic myotomy: anterior versus posterior approach: a randomized single-blinded clinical trial

2020 ◽  
Vol 91 (2) ◽  
pp. 288-297.e7 ◽  
Author(s):  
Mouen A. Khashab ◽  
Omid Sanaei ◽  
Jerome Rivory ◽  
Nicholas Eleftheriadis ◽  
Philip Wai Yan Chiu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Posterior Approach ◽  
Peroral Endoscopic Myotomy ◽  
Endoscopic Myotomy

scholarly journals Changes in weight following peroral endoscopic myotomy: results from a North American center

2021 ◽  
Vol 09 (10) ◽  
pp. E1491-E1496
Author(s):  
Simon Hew ◽  
Douglas Motomura ◽  
Robert Bechara
Keyword(s):  
Weight Gain ◽  
North American ◽  
Clinical Success Rate ◽  
Normal Weight ◽  
Peroral Endoscopic Myotomy ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Weight Category ◽  
Endoscopic Myotomy

Abstract Background and study aims Weight loss is a feature of untreated achalasia. While weight gain after achalasia treatment is expected, little data exist about the extent of it, particularly after peroral endoscopic myotomy (POEM). We aimed to describe the changes in weight after POEM. Patients and methods A retrospective analysis was performed of patients from March 2016 to March 2020 undergoing POEM by an experienced operator at an academic referral center in Kingston, Ontario, Canada. Data examined included pre- and post-POEM body mass index (BMI), procedural characteristics, and Eckardt scores. Results Ninety-two patients underwent POEM during the study period, for 77 of whom follow-up data were available including BMI. Prior to POEM, the median BMI was 26. Six patients (7.8 %) were considered to be underweight, 24 (31.2 %) were normal, 26 (33.8 %) were pre-obese, and 21 (27.2 %) were obese. At a median follow-up of 15 months, the clinical success rate was 95 %. Patients in the normal weight and pre-obesity categories had a significant increase in weight post-POEM. Of the underweight patients, two (33.3 %) moved up to a normal weight category and two (33.3 %) became pre-obese. In the normal BMI category, eight (37.5 %) became pre-obese and one patient (4.2 %) became obese. Ten of the 26 pre-obese patients (38.4 %) were obese post-POEM. Seven of the obese patients (33.3 %) reached Class III (morbid) obesity at follow-up.  Conclusions Patients may experience a marked increase in BMI following POEM, with over one-third of patients becoming pre-obese, obese or morbidly obese at follow-up in our study in a North American population. Further study is required to analyze weight gain patterns post-POEM.

Sign in / Sign up

Export Citation Format

Share Document