Third-space endoscopy to the rescue: what is the role of gastric peroral endoscopic myotomy in the management of gastric sleeve stenosis?

Background/aims: Traditional endoscopic treatments have limited success for treatment of gastric sleeve stenosis (GSS). Gastric peroral endoscopic myotomy (G-POEM) could conceivably obliterate the twist/angulation that causes GSS through a tunneled stricturotomy (instead of pyloromyotomy). We report early outcomes of G-POEM for GSS treatment. Methods: We retrospectively reviewed all patients with GSS treated with G-POEM at a single center. The primary endpoint was clinical success, defined as symptom improvement with resumption of adequate oral intake, without requiring further intervention. Results: 13 patients (12 female, mean age 43±10.9 years) underwent G-POEM for predominantly helical (n=11, 85%) GSS. Three (23%) had concurrent sleeve leak and ten (77%) had prior GSS treatment. There were two intraoperative AEs resulting in no deviation to the procedure. No major AEs occurred. At a median 175 (IQR119-260) days follow up, clinical success was achieved in 10 patients (77%). Median GCSI score in responders decreased post-G-POEM from 2.06 (IQR1.5-2.8) to 0.39 (IQR0.2-0.5). Three patients (23%) required surgical revision. Conclusions: G-POEM is a feasible and safe technique which may provide an alternative option for those averse to undergoing surgical revision for treatment of GSS.

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PERORAL ENDOSCOPIC MYOTOMY IN TREATMENT OF THE ESOPHAGEAL ACHALASIA AT CHILDREN

PEDIATRIA Journal named after G N SPERANSKY ◽

10.24110/0031-403x-2020-99-6-241-246 ◽

2020 ◽

Vol 99 (6) ◽

pp. 241-246

Author(s):

Yu.A. Kozlov ◽

◽

A.A. Smirnov ◽

A.A. Rasputin ◽

P.A. Baradieva ◽

...

Keyword(s):

Esophageal Achalasia ◽

Peroral Endoscopic Myotomy ◽

Heller’S Myotomy ◽

Endoscopic Method ◽

Therapeutic Procedures ◽

Heller's Myotomy ◽

Prolonged Observation ◽

Endoscopic Myotomy ◽

Esophageal Sphincter

Etiological treatment of esophageal achalasia are absent. None of the currently available treatment methods can restore normal esophageal peristalsis and the functionality of the lower esophageal sphincter, thereby alleviating dysphagia and other symptoms of achalasia. Therapeutic procedures currently used for the effective treatment of achalasia of the esophagus are represented by laparoscopic Heller's myotomy and endoscopic balloon dilatation of the esophagus. According to the literature, Heller's myotomy is considered as a method of choice in children, since it provides more reliable results in comparison with pneumatic expansion during prolonged observation. Peroral endoscopic myotomy (POEM) is a new endoscopic method for the treatment of esophageal achalasia, first reported by P. Pasricha in experiment, and then H. Inoue performed this operation in adult patients. There are only a few studies on the use of POEM in children and adolescents. Existing studies have demonstrated the feasibility of this procedure in children, low level of complications and excellent results with short-term observation. Several studies have reported high efficacy in the use of POEM in children, ranging from 90% to 100%. Reports of the occurrence of complications after POEM in children are sporadic and are represented by the formation of subcutaneous emphysema, carboperitoneum, retroperitoneum and mediastinal emphysema. Obviously, detailed studies with longer observation are required before the role of POEM in the treatment of esophageal achalasia in children can be established. If preliminary results are confirmed, POEM can be a real alternative to Heller's myotomy in pediatric patients. This study is intended to explore the potential and safety of the use of POEM for the treatment of achalasia in children based on a review of existing data in the scientific literature.

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

Digestive Diseases ◽

10.1159/000516024 ◽

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.

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Complementary role of EUS, EndoFLIP, and manometry for management of type III achalasia with peroral endoscopic myotomy in a patient with compensated cirrhosis and no varices

VideoGIE ◽

10.1016/j.vgie.2020.12.010 ◽

2021 ◽

Author(s):

M. Phillip Fejleh ◽

Rena Yadlapati ◽

Michel H. Mendler ◽

Rohit Loomba ◽

Wilson T. Kwong ◽

...

Keyword(s):

Peroral Endoscopic Myotomy ◽

Type Iii ◽

Compensated Cirrhosis ◽

Complementary Role ◽

Endoscopic Myotomy ◽

Type Iii Achalasia

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

10.21203/rs.2.20562/v2 ◽

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.

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