scholarly journals V-OG05 Robotic Hellers Myotomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Ben Knight
Keyword(s):  
Balloon Dilation ◽  
Rare Condition ◽  
Muscle Fibres ◽  
Vagal Nerves ◽  
Liver Retractor ◽  
Endoscopic Myotomy ◽  
Oesophageal Myotomy ◽  
Long Myotomy ◽  
Robotic Instruments ◽  
Botox Injection

Abstract Background Achalasia is a rare condition affecting less than 1:100,000 patients. Treatment for this rare condition include balloon dilation, botox injection, endoscopic myotomy (POEMS) or surgical myotomy. Laparoscopic surgical myotomy is the “go to” approach for most surgeons; it is tried and tested, can be performed safely and quickly with a low complication rate, minimal pain and a short length of stay. Methods This video presents the technique adopted for robotic oesophageal myotomy in a patient with type II achalasia. A 4 arm technique was adopted with arm 4 on the patients left. The Davinci X system was used in this case. A Nathensen liver retractor was used to retract the liver; robotic instruments included the hook and cadiere forceps x2. Results The procedure was successfully performed; the operative time was 53 minutes, LOS was <24 hours. Check endoscopy revealed a wide open gastro-oesophageal junction and a long myotomy. The patient noted an improvement in symptoms with 24 hours and has had no significant reflux. Conclusion The enhanced magnified 3D view on the robotic platform allows better visualisation of the hiatal structures, vagal nerves and muscle fibres when performing the myotomy. Using the 4th arm to retract the lateral edge of the oesophageal muscle provides a very safe and stable platform to perform a long myotomy. I think the robotic system should be adopted as the standard approach for a hellers myotomy.

PS01.021: SHORT POEM GUIDED BY ENDOFLIP RESULTS IN LESS REFLUX RATE IN PATIENTS SUFFERING FROM ACHALASIA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 56-56
Author(s):  
Lavinia Barbieri ◽  
Andrei Ilczysyn ◽  
Jafar Jafari ◽  
Abraham Botha ◽  
Edel Smyth
Keyword(s):  
Conflicts Of Interest ◽  
Ph Monitoring ◽  
Symptom Relief ◽  
High Resolution Manometry ◽  
Historic Control ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter ◽  
Long Myotomy

Abstract Background Peroral Endoscopic Myotomy (POEM) has gained ground for achalasia tratment. Although laparoscopic Heller's-Dor (LHD) is a proven intervention, the cut of the inner muscular layer during POEM offers a goal-directed procedure. However, concerns regarding post-procedure reflux had been raised. As during POEM long myotomy is generally adviced, we decreased the length to reduce reflux after treatment. Methods 19 patients with type 1 or 2 achalasia underwent POEM guided intraoperatively by Endoflip® (Crospon Ltd., Galway, Ireland) to target the myotomy where the major point of tightness was. We aimed for an increase of compliance and distensibility of three times of the lower esophageal sphincter (LOS) via a short myotomy. We compared these patients with a historic control LHD group of 15 patients in terms of Eckardt's score, GERD-HRQL questionnaire, high-resolution manometry to check pressure of the LOS 24h pH-impedence to measure acid exposure with minimum follow-up of 9 months. Results Length of myotomy was 7 cm (6–10) for POEM and 9 cm for LHD. Median Eckard's score after POEM was 0.5 versus 2 for LHD group. Median Eckardt's score and GERD-HRQL were 0.5 vs 2 and 13 vs 15, respectively after POEM or LHD. 24h pH-monitoring revealed pathologic reflux in one patient after POEM and in 3 after LHD, with median acid % time of 0,1 vs 1,2. Data are summarized in table. Conclusion POEM is effective in achieving symptom relief in patient with achalasia. Although randomized data are not available, reflux rate after POEM with short myotomy guided by Endoflip is comparable with LHD and lower than the data of literature. Disclosure All authors have declared no conflicts of interest.

scholarly journals Endoscopic approaches to treatment of achalasia

2012 ◽  
Vol 6 (2) ◽  
pp. 115-135 ◽  
Author(s):  
Stavros N. Stavropoulos ◽  
David Friedel ◽  
Rani Modayil ◽  
Shahzad Iqbal ◽  
James H. Grendell
Keyword(s):  
Botulinum Toxin Injection ◽  
Balloon Dilation ◽  
Pneumatic Dilation ◽  
Endoscopic Stent ◽  
Extensive Training ◽  
Treatment Paradigm ◽  
Endoscopic Myotomy ◽  
Large Balloon ◽  
Esophageal Sphincter ◽  
Per Oral

Endoscopic therapy for achalasia is directed at disrupting or weakening the lower esophageal sphincter (LES). The two most commonly utilized endoscopic interventions are large balloon pneumatic dilation (PD) and botulinum toxin injection (BTI). These interventions have been extensively scrutinized and compared with each other as well as with surgical disruption (myotomy) of the LES. PD is generally more effective in improving dysphagia in achalasia than BTI, with the latter reserved for infirm older people, and PD may approach treatment results attained with myotomy. However, PD may need to be repeated. Small balloon dilation and endoscopic stent placement for achalasia have only been used in select centers. Per oral endoscopic myotomy is a newer endoscopic modality that will likely change the treatment paradigm for achalasia. It arose from the field of natural orifice transluminal endoscopic surgery and represents a scarless endoscopic approach to Heller myotomy. This is a technique that requires extensive training and preparation and thus there should be rigorous accreditation and monitoring of outcomes to ensure safety and efficacy.

scholarly journals Granulomatous interstitial polymyositis and intramuscular neuritis in a dog

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Josefin Hultman ◽  
Marco Rosati ◽  
Tone Kristensen Grøn ◽  
Kaspar Matiasek ◽  
Cathrine Trangerud ◽  
...  
Keyword(s):  
Neuromuscular Disorders ◽  
Clinical Signs ◽  
Granulomatous Inflammation ◽  
Rare Condition ◽  
Giant Cells ◽  
Muscle Fibres ◽  
Glucocorticoid Treatment ◽  
Long Term Treatment ◽  
Granulomatous Myositis ◽  
Muscle Biopsies

Abstract Background Granulomatous myositis is a rare condition in both humans and dogs. In humans it is most frequently related to sarcoidosis, where a concurrent granulomatous neuritis has been reported occasionally. Simultaneous granulomatous myositis and neuritis have been diagnosed previously in dogs (unpublished observations), but have not been studied further. Additional investigations are therefore warranted to characterize this disorder. Here we present a detailed description of concurrent idiopathic granulomatous myositis and granulomatous neuritis in a dog with suspected immune-mediated aetiology. Case presentation The dog presented with dysphonia and paresis in the pelvic limbs and tail. In addition to muscle biopsies being taken for histopathology, magnetic resonance imaging, computed tomography and electrodiagnostics were performed. Muscle biopsies displayed granuloma formation with giant cells and epithelioid macrophages in muscle fibres and nerve branches. Microorganisms were not detected. Long-term treatment with glucocorticoids was clinically successful. Two years after the clinical signs started, the dog presented with signs of sepsis and died. Histopathologically, no granulomatous inflammation could be demonstrated in either muscles or nerves at that time. Conclusions This case illustrates a granulomatous interstitial polymyositis and intramuscular neuritis that improved clinically and resolved histologically with glucocorticoid treatment. Idiopathic granulomatous myositis and neuritis should be considered as a differential diagnosis in dogs with clinical signs of neuromuscular disorders.

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.

Superior clinical outcomes of peroral endoscopic myotomy compared with balloon dilation in all achalasia subtypes

2019 ◽  
Vol 34 (4) ◽  
pp. 659-665 ◽  
Author(s):  
Ga Hee Kim ◽  
Kee Wook Jung ◽  
Hwoon‐Yong Jung ◽  
Min‐Ju Kim ◽  
Hee Kyong Na ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Balloon Dilation ◽  
Peroral Endoscopic Myotomy ◽  
Endoscopic Myotomy

Benign acute childhood myositis: importance of early recognition

2019 ◽  
Vol 28 (9) ◽  
pp. 560-564
Author(s):  
Amanda Catherine Steinson ◽  
Tayyib Mubashar ◽  
Alison Frances Janzen ◽  
Dawn Poulton ◽  
Siba Prosad Paul
Keyword(s):  
Creatine Kinase ◽  
Lower Limb ◽  
Joint Pain ◽  
Early Recognition ◽  
Rare Condition ◽  
Calf Muscle ◽  
Muscle Fibres ◽  
Limb Pain ◽  
Lower Limb Pain ◽  
Supportive Management

Cases of children presenting with limb or joint pain are relatively common and are due mainly to benign conditions. Early diagnosis will help reduce unnecessary invasive investigations so, although a relatively rare condition, benign acute childhood myositis (BACM), which presents with acute lower limb pain and an isolated rise in creatine kinase, should be considered. BACM is characterised by an infiltration of viruses into calf muscle fibres, which may cause a subsequent inflammatory response leading to calf-muscle pain. Symptomatic and supportive management, along with explanation and reassurance, is all that is required in managing this condition. This article discusses the management of a 10-year-old boy with a classical presentation of BACM, alongside differentials and management for clinician consideration.

scholarly journals Diagnosis and Management of Achalasia: Updates of the Last Two Years

2021 ◽  
Vol 10 (16) ◽  
pp. 3607
Author(s):  
Amir Mari ◽  
Fadi Abu Baker ◽  
Rinaldo Pellicano ◽  
Tawfik Khoury
Keyword(s):  
Heller Myotomy ◽  
Neurodegenerative Disorder ◽  
Balloon Dilation ◽  
Therapeutic Endoscopy ◽  
Laparoscopic Heller Myotomy ◽  
Clinical Approach ◽  
High Resolution Manometry ◽  
Pneumatic Balloon Dilation ◽  
Endoscopic Myotomy ◽  
Per Oral

Achalasia is a rare neurodegenerative disorder causing dysphagia and is characterized by abnormal esophageal motor function as well as the loss of lower esophageal sphincter (LES) relaxation. The assessment and management of achalasia has significantly progressed in recent years due to the advances in high-resolution manometry (HRM) technology along with the improvements and innovations of therapeutic endoscopy procedures. The recent evolution of HRM technology with the inclusion of an adjunctive test, fluoroscopy, and EndoFLIP has enabled more precise diagnoses of achalasia to be made and the subgrouping into therapeutically meaningful subtypes. Current management possibilities include endoscopic treatments such as Botulinum toxin injected to the LES and pneumatic balloon dilation. Surgical treatment includes laparoscopic Heller myotomy and esophagectomy. Furthermore, in recent years, per oral endoscopic myotomy (POEM) has established itself as a principal endoscopic therapeutic alternative to the traditional laparoscopic Heller myotomy. The latest randomized trials report that POEM, pneumatic balloon dilatation, and laparoscopic Heller’s myotomy have comparable effectiveness and complications rates. The aim of the current review is to provide a practical clinical approach to dysphagia and to shed light on the most recent improvements in diagnostics and treatment of achalasia over the last two years.

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