558 OUTCOMES OF PER ORAL ENDOSCOPIC MYOTOMY IN ACHALASIA IN PATIENTS WITH END-STAGE ESOPHAGUS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Siva Raja ◽  
Saurav Adhikari ◽  
Monisha Sudarshan ◽  
Madhusudhan Sanaka ◽  
Sudish Murthy ◽  
...  

Abstract   Per oral endoscopic myotomy (POEM) has emerged as a favorable alterative to Heller myotomy for achalasia. However data is limited on the effectiveness in palliation of symptoms in patients who have an esophagus with a sigmoid/tortuous configuration, or a mega-esophagus with width more than 5 cm, due to long-standing achalasia. Our objective is to investigate the outcomes after POEM procedure in patients diagnosed with achalasia and considered end-stage. Methods A retrospective cohort study was conducted in a large hospital between April 2014 and July 2019. A total of 504 patients were identified with 218 undergoing POEM during the study time period of which 57 patients had a sigmoid or tortuous esophagus, and/or had a barium column width of more than 5 cm on timed barium esophagograms (TBE). Primary outcome was symptom relief during follow-up, defined as a post-operative Eckardt score ≤ 3. We also explored integrated resting pressure (IRP) on manometry, barium column height and width on TBE, complications and procedure related parameters. Statistical analyses were performed using R. Results Significant decrease in median Eckardt scores were observed, 7.5 [6,8.8] pre-operatively to 0 [0,1] at 2 months (p < 0.001). At 2 years, 12 of 14 patients (85%), reported scores of ≤3. Improvements at 2 months were noted in median IRP (25.4 mmHg [15.5, 35.9] vs. 4.0 mmHg [2.2,9.0]), 1 min TBE height (11.5 cm [7.5,15.0] vs. 6.8 cm [4.7,9.0]) and width (5.0 cm [4.1,6.1] vs. 2.8 cm [1.9,3.1]), p < 0.001. At 2 years, they were 9.5 cm [5,12.8] and 3.0 cm [2.4,4.5], respectively. Post-operative pH studies in 35(61%) patients demonstrated a DeMeester score ≥ 14.72 in 17(49%) patients. Almost all patients reported return to activities of daily living within 7 days. Conclusion POEM is an effective and safe modality in achalasia patients with end-stage esophagus. Patients in this cohort historically have had poor outcome to interventions and our data shows excellent short-to-medium term outcome with low morbidity after POEM. Given its efficacy, minimal invasiveness and short return to function, POEM is a reasonable first and gold standard palliative therapy in this difficult cohort and should be attempted before considering esophagectomy.

Author(s):  
Eitan Podgaetz ◽  
Vani Konda

Abstract Objective With the advent of minimally invasive surgery, incisionless surgery, and third-space endoscopy, the treatment for Zenker's diverticulum has also moved toward less invasive techniques Methods New incisionless per oral techniques can be applied for cricopharyngeal myotomy in Zenker's diverticulum. Results Five patients underwent Zenker's diverticulum per oral endoscopic myotomy (Z-POEM) without complications, minimal discomfort, and narcotic consumption, with complete resolution of their symptoms by history and Eckardt scores. Conclusions Z-POEM is performed entirely endoscopically with very little associated pain or complication rates, with short-term follow-up having excellent functional and symptomatic results.


Dysphagia ◽  
2021 ◽  
Author(s):  
Jayanta Samanta ◽  
Harshal S. Mandavdhare ◽  
Naveen Kumar ◽  
Praveen Kumar-M ◽  
Anudeep Jafra ◽  
...  

2014 ◽  
Vol 28 (4) ◽  
pp. 1333-1333 ◽  
Author(s):  
Ahmed Sharata ◽  
Ashwin A. Kurian ◽  
Christy M. Dunst ◽  
Neil H. Bhayani ◽  
Kevin M. Reavis ◽  
...  

2015 ◽  
Vol 81 (5) ◽  
pp. AB497
Author(s):  
Amit Bhatt ◽  
Bradley Confer ◽  
Jordan Holmes ◽  
Matthew Kroh ◽  
Scott L. Gabbard ◽  
...  

2018 ◽  
Vol 32 (7) ◽  
pp. 3046-3054 ◽  
Author(s):  
Sunil Dacha ◽  
Lei Wang ◽  
Xaioyu Li ◽  
Yueping Jiang ◽  
George Philips ◽  
...  

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