PS01.115: ESOPHAGECTOMY FOR ACHALASIA CARDIA: A SINGLE TEAM EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 82-82
Author(s):  
Servarayan Chandramohan ◽  
Kanagavel Manickavasagam ◽  
Madeshwaran Chinnathambi ◽  
Abishai Jebaraj ◽  
Apsara Chandramohan ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
High Volume ◽  
Transhiatal Esophagectomy ◽  
Pneumatic Dilatation ◽  
Duration Of Symptoms ◽  
Achalasia Cardia ◽  
Esophagus Perforation ◽  
Per Oral ◽  
Sigmoid Esophagus

Abstract Background In the era of per oral endoscopic myotomy, advancement in manometry and laparoscopy the treatment for achalasia cardia is well defined. Oesophagectomy has only a limited role in rare patients with sigmoid esophagus, perforation during nonsurgical treatment and malignancy. This study is about the indications of esophagectomy for achalasia cardia from one of the high volume centers for upper gastrointestinal disorders in India Methods This study includes 10 patients (7 male, 3 female) between august 2010 to august 2016.They had symptoms like dyspnea, dysphagia, regurgitation, chest discomfort, weight loss and cough. The duration of symptoms range from 2–120 months. Seven patients underwent previous pneumatic dilatation, four underwent Laproscopic Hellers cardiomyotomy with fundoplication (dor 3, toupet 1) and one patient had both pneumatic dilatation and cardiomyotomy. Results The indications for esophagectomy were sigmoid esophagus, failed pneumatic dilatation and laproscopic hellers cardiomyotomy, perforation after pneumatic dilatation and malignancy. The procedures done were transhiatal esophagectomy with stomach pull-up in 8 patients, Transthoracic esophagectomy in one, Esophagogastrectomy with transabdominal intrathoracic esophagojejunal anastomosis in one patient. The follow-up range between 14–84 months. During follow-up one patient developed hepatocellular carcinoma right lobe and died. Conclusion In the era where nonresection treatment play a major role in the management of achalasia cardia, esophagectomy still has a role in select patients. The indications for esophagectomy in our series included failed endotherapy, failed Hellers cadiomyotomy, sigmoid esophagus and malignancy. Disclosure All authors have declared no conflicts of interest.

TP6.2.14 Outcome of POEM (Per-oral endoscopic myotomy) for achalasia

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Annabelle White ◽  
Woochan Hwang ◽  
Alekhaya Kotta ◽  
Daniel Beasley ◽  
Katarina Chow ◽  
...  
Keyword(s):  
Clinical Success ◽  
Pneumatic Dilatation ◽  
Demeester Score ◽  
First Line Therapy ◽  
Eckardt Score ◽  
Operative Endoscopy ◽  
Endoscopic Myotomy ◽  
Oesophageal Achalasia ◽  
Per Oral

Abstract Aims Laparoscopic Heller’s myotomy (LHM) has been the surgical gold standard for treatment of oesophageal achalasia. Peroral endoscopic myotomy (POEM) has been proposed as an alternative technique. The aim of this study was to assess the safety and efficacy of POEM for achalasia in our unit. Methods We have operated on 202 patients for oesophageal achalasia since 2005: 107 had LHM, 86 had POEM, and 9 had an oesophagectomy. We assessed the clinical outcome of POEM comparing pre- and postoperative endoscopic, radiologic and manometric findings, as well as Eckardt-, GERD- and DsQoL score for achalasia. All follow-up patients were offered endoscopy. Results Data were completed for the first 45 POEM patients. The average age was 45 years. 18 patients (40%) had prior achalasia treatment. The median hospital stay was 2 days (2-5). There was no mortality, but 4 patients (9%) had post-operative complications. The median follow-up was 24 months (12-49). Clinical success (Eckardt score ≤ 3) was achieved in 39 patients (87%). Thirteen patients (29%) were taking PPIs for chest symptoms. Eleven of these underwent pH studies of whom only 1 had a DeMeester score > 14.5. Of the 24 patients who had post-operative endoscopy, 40% was diagnosed with oesophagitis grade A, yet only 5 of them were symptomatic. Conclusions POEM appears to be safe and effective and warrants consideration as first-line therapy in expert achalasia centres. Longer term randomized studies comparing the outcomes of POEM with LHM and pneumatic dilatation will determine its place in the treatment of achalasia.

PS01.018: PERSISTENT DYSPHAGIA AFTER FUNDOPLICATION WITH MESH PLASTY –MISSED OR MISTAKEN –A CASE REPORT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 55-55
Author(s):  
Servarayan Chandramohan ◽  
Visvarath Varadharajan ◽  
Madeshwaran Chinnathambi ◽  
Kanagavel Manickavasagam ◽  
Abishai Jebaraj ◽  
...  
Keyword(s):  
Skin Biopsy ◽  
Mesh Repair ◽  
Conflicts Of Interest ◽  
Case Reports ◽  
Systemic Disease ◽  
Transhiatal Esophagectomy ◽  
High Resolution Manometry ◽  
Failed Fundoplication ◽  
Rule Out

Abstract Background Scleroderma esophagus is a rare entity. Only few case reports of esophagectomy were done and reported for this condition. We are presenting this rare case of failed fundoplication and mesh repair with a diagnosis of GERD and hiatus hernia, which was found later on due to Scleroderma with Esophageal involvement. Methods 58 year old female admitted with dysphagia following laproscopic fundoplication with mesh repair of crura with a diagnosis of GERD and hiatus hernia.She presented with persistent vomiting and loss of weight.On evaluation, her Upper GI scopy revealed dilated esophagus with sluggish peristalisis. Since the patient had tightness of skin over the distal extremities, face and fish mouth appearance with thinning of nail, Skin biopsy was taken. The skin biopsy was reported to be scleroderma.The esophageal manometry demonstrated failed esophageal peristalisis with high normal LES pressure due to tight fundal wrap.The patient was treated with mesh remova, Transhiatal esophagectomy with gastric pull-up and cervical Anastomosis.Post operatively the patient was treated with hydrocholoroquine and predinisolone. Results The patient is free of dysphagia and is on regular follow up. Conclusion In case of failure, detailed evaluation including High resolution manometry (MII HRM) has to be done before doing laparoscopic fundoplication for GERD has to rule out uncommon and rare disorders of esophagus. Detailed clinical examination in GERD patients has to be done to rule out systemic disease like scleroderma.In case of failed fundoplication for GERD, patients have to investigated for the failure.So patients with incapacitating esophageal neuromotor disease, a more radical approach in the form of esophagectomy may be safer and more reliable than attempting another procedure and risk another failure. Disclosure All authors have declared no conflicts of interest.

scholarly journals High-volume image-guided injection in the chronic recalcitrant non-insertional patellar tendinopathy: a retrospective case series

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Torsten Grønbech Nielsen ◽  
Lene Lindberg Miller ◽  
Bjarne Mygind-Klavsen ◽  
Martin Lind
Keyword(s):  
Case Series ◽  
High Volume ◽  
Patellar Tendinopathy ◽  
Retrospective Case ◽  
Duration Of Symptoms ◽  
Image Guided ◽  
Tendon Thickness ◽  
Retrospective Case Study

Abstract Purpose To evaluate if High-volume Image-guided Injection (HVIGI)-treatment for chronic Patellar tendinopathy (PT) improve function and reduce pain at 16-months follow-up. Methods Patients with resistant PT who failed to improve after a three-month eccentric loading program were included in the study. Maximal tendon thickness was assessed with ultrasound. All patients were injected with 10 mL of 0.5% Marcaine, 0.5 mL Triamcinolonacetonid (40 mg/mL) and 40 mL of 0.9% NaCl saline solution under real-time ultrasound-guidance and high pressure. All outcome measures were recorded at baseline and at 16 months. A standardised Heavy Slow Resistance rehabilitation protocol was prescribed after HVIGI-treatment. Clinical outcome was assessed with the Victorian Institute of Sports Assessment-Patella tendon questionnaire (VISA-P) and statistically analyses were performed. Results The study included 28 single treatment HVIGI procedures in PT in 23 patients (19 men, 4 women) with a mean age of 30.3 (range 19–52). The mean duration of symptoms before HVIGI was 33 months. The baseline VISA-P score of 43 ± 17 (range 15–76) improved to 76 ± 16 (range 42–95) after 16 months (p < 0.01). Of the 28 HVIGI procedures 12 patients (15 PT) were not satisfied after the initial HVIGI procedure. Of these, 5 patients (5 PT) had additional HVIGI, 2 patients (2 PT) had corticoid injection and 6 patients (8 PT) needed surgery. Of the remaining 11 patients (13 PT), 9 patients had more than a 13-point improvement in the VISA-P score after 16 months. Conclusions In this retrospective case-study, only 9 patients (32%) did benefit of a single HVIGI treatment at 16-months and a 33-point significant improvement was seen on the VISA-P score.

PS01.023: EXTENDING MYOTOMY BOTH DOWNWARDS AND UPWARDS FOR MANOMETRIC PATTERN III ACHALASIA PATIENTS IMPROVES THE FINAL OUTCOME

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 56-57
Author(s):  
Renato Salvador ◽  
Giovanni Capovilla ◽  
Luca Provenzano ◽  
Dario Briscolini ◽  
Anna Perazzolo ◽  
...  
Keyword(s):  
Symptom Score ◽  
Time Window ◽  
Conflicts Of Interest ◽  
Final Outcome ◽  
Barium Swallow ◽  
Partial Fundoplication ◽  
Laparoscopic Myotomy ◽  
Duration Of Symptoms ◽  
Study Population

Abstract Background Achalasia is at present classified in 3 manometric patterns. Pattern III is the most unfrequent pattern and is correlated with the worst outcome after all available treatments. We aimed to investigate the final outcome after classic laparoscopic myotomy (length ≤ 8cm, CLM) as compared with a longer laparoscopic myotomy both downwards and upwards with (length > 8cm, LLM) in patients with pattern III achalasia. Methods The study population consisted of 50 consecutive patients with pattern III achalasia who underwent laparoscopic myotomy between 1997–2017. Patients who had already been treated with surgical or endoscopic procedures were ruled out. Patients before 2010 had a traditional CLM procedure while patients after 2010 had a LLM. Symptoms were collected and scored using a detailed questionnaire; barium-swallow, endoscopy, manometry (conventional or HRM) were performed, before and after surgical treatment. Results Of the 50 patients representing the study population, 23 had CLM and 27 had LLM. In addition, all the patients add an anterior, partial fundoplication (Dor). The patients’ demographic and clinical parameters (sex, symptom-score, duration of symptoms, esophageal-diameter) were similar in both groups. No intraoperative mucosal lesions were detected. The median length of the myotomy was 7 cm (IQR:7–8) in the CLM and 10 cm (IQR:10–11) in the LLM (P < 0.001). The median of follow-up was 61 months (IQR:35–93) in the CLM and 24 months (IQR:16–36) in the LLM. As a whole, the two groups had a different drop in their symptom score: 21 (17–26) versus 6 (0–8), and 21 (18–27) versus 3 (0–6) for the CLM and LLM respectively (P < 0.05). Moreover, failures were 7/23 (30%) in the CLM and 3/27 (11.1%) in the LLM (P < 0.001). An abnormal acid exposure was detected after the treatment in 4 patients of CLM and in 3 of LLM (P = n.s.). Conclusion In spite of intrinsic limitations of the study (retrospective, different time window of the two procedures and different follow-up), the extension of the length of the myotomy both downwards and upwards improves the final outcome of the laparoscopic Heller-Dor procedure in patients with pattern III achalasia. On the other hand, a longer myotomy does not influence the development of postoperative gastroesophageal reflux. Disclosure All authors have declared no conflicts of interest.

PS02.007: DEVELOPING A ROBOT-ASSISTED ESOPHAGECTOMY PROGRAM IN A HIGH-VOLUME TRANSHIATAL ESOPHAGECTOMY CENTER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 122-122
Author(s):  
Toby Keeney-Bonthrone ◽  
Andrew Chang ◽  
Jules Lin ◽  
William Lynch ◽  
Philip Carrott ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Conflicts Of Interest ◽  
High Volume ◽  
Pulmonary Complications ◽  
Transhiatal Esophagectomy ◽  
Perioperative Outcomes ◽  
Multivariate Logistic Regression Model ◽  
High Morbidity ◽  
Complication Rates ◽  
Robot Assisted

Abstract Background Esophagectomies have high morbidity rates regardless of approach. Minimally invasive approaches have been shown to have lower complication rates compared to open operations for Transthoracic and Three-hole (McKeown type) esophagectomies. We examined the perioperative outcomes of a transhiatal robot-assisted approach compared to concurrent transhiatal esophagectomies at the same institution. Methods A retrospective review was performed of all transhiatal and robot-assisted transhiatal esophagectomies performed for esophageal cancer at a single large academic center between January 2013 and December 2017. Outcomes assessed included postoperative complications, procedure time, length of stay, unexpected ICU admissions, 30-day readmission and 30-day mortality. A multivariate logistic regression model, adjusted for demographics, comorbidities and disease severity, was used to evaluate outcomes. Results 378 transhiatal (THE) and 87 robot-assisted (RTHE) esophagectomies met inclusion criteria. RTHE was associated with higher rates of pleural effusion requiring drainage, pneumothorax, pulmonary embolism and respiratory failure, as well as empyema requiring treatment. RTHE was associated with a higher number of lymph nodes resected. 56.3% of RTHEs used epidurals vs. 92.3% of THEs. Epidural use had no statistical association with the incidence of pulmonary complications. Differences in atrial fibrillation, anastomotic leak, pneumonia, procedure length, length of stay, 30-day survival and readmission rates were not statistically significant. Conclusion Implementation of a new robot-assisted transhiatal esophagectomy program was associated with higher rates of pulmonary complications and empyema, although there were no differences in length of stay. Further investigation is needed to understand the difference in complications. Disclosure All authors have declared no conflicts of interest.

scholarly journals Clinical Outcome of Pneumatic Dilatation in Patients with Achalasia Cardia: A Single-Center Prospective Study

2017 ◽  
Vol 08 (04) ◽  
pp. 182-186
Author(s):  
Amit Hanmant Shejal ◽  
Thazhath Mavali Ramachandran ◽  
Sunil Kumar N
Keyword(s):  
Clinical Improvement ◽  
Balloon Dilation ◽  
Pneumatic Dilatation ◽  
Term Therapy ◽  
Symptom Duration ◽  
Achalasia Cardia ◽  
Eckardt Score ◽  
Long Term Therapy

ABSTRACT Background and Aim: Pneumatic balloon dilation is one of the most commonly used and effective methods for treating patients with achalasia cardia. This study was performed to assess immediate and long-term response of pneumatic dilatation (PD) in these patients. Materials and Methods: Forty-four achalasia cardia patients, who underwent PD in our center from January 2013 to December 2015, were prospectively studied. Data from these patients were analyzed for clinical improvement in symptoms after dilatation procedure over this period as per Eckardt score. Patients who required repeated procedure and factors influencing remission of symptoms were analyzed. Results: A total of 44 patients underwent PD, among which three lost to follow up. Of the 41 patients, 21 were male (51.22%) and 20 were females (48.78%). Mean age was 38.68 (13–64) years. Median symptom duration before first dilatation was 18 months (2–240). Major symptoms at presentation were dysphagia (n = 41, 100%), regurgitation (n = 38 92.68%), chest pain (n = 31, 75.6%), and weight loss (n = 20, 48.78%). Mean follow-up period was 22.22 months (9–38). Forty (97.56%) patients had immediate clinical improvement after 1 dilatation, of which 38 (92.68%) patients did not require any further treatment. Mean Eckardt score was 6.82 (4–11) at the time of first dilatation which improved to 0.66 during follow-up. Two patients required second dilatation (one 5 months and other 18 months after the first procedure). Conclusion: PD is a safe and effective long-term therapy for achalasia cardia and has a good long-term clinical remission.

scholarly journals P03 Service evaluation of ankle damage in a single centre paediatric cohort of juvenile idiopathic arthritis

Rheumatology ◽  
2019 ◽  
Vol 58 (Supplement_4) ◽  
Author(s):  
Sunil Sampath ◽  
Alyssa Nathaniel ◽  
Raj Sinha ◽  
Antoine De Gheldere ◽  
Ethan Sen ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Ankle Joint ◽  
Conflicts Of Interest ◽  
Joint Damage ◽  
Disease Course ◽  
Single Centre ◽  
Duration Of Symptoms ◽  
Radiological Evidence ◽  
Mri Features

Poster presentation Tuesday 8 October Background The ankle is one of the most commonly affected joints in juvenile idiopathic arthritis (JIA) and ankle joint damage is a known complication. The frequency of ankle damage in modern JIA cohorts is unknown and optimal management pathways are unclear. Magnetic resonance imaging (MRI) is the most sensitive imaging modality for the assessment of joint damage. The aim of this analysis was to investigate the demographics, disease features and management of JIA patients with MRI changes consistent with ankle damage. Methods A single-centre, retrospective study over a four year period was conducted. JIA cases with damage based on MRI features were included in the study. MRI was reviewed by an experienced musculoskeletal radiologist and joint damage was defined as radiological evidence of cartilage loss or joint space narrowing. A standardised electronic pro forma was used to record demographics, disease features and treatments received. Results Fifty one JIA cases had an MRI scan during the study period and 16/51 (31%) had radiological evidence of ankle damage at a median interquartile range (IQR) follow-up of 7.6 (6.9 – 11.0) years; 7/16 (44%) had developed bilateral ankle damage. The median (IQR) duration of symptoms at diagnosis was 2(1.0-10.5) months. The mean age at diagnosis and at detection of ankle damage was 5.2 years and 12.1 years respectively. The most frequent JIA subtype was oligo-articular extended (50%), and 50% were ANA positive. The median (IQR) duration between detection of ankle damage and first episode of ankle synovitis was 5.4 (4.6 – 6.4) years. Ankle synovitis was present at diagnosis in 10/16 (62%). Median (IQR) number of ankle corticosteroid injections before the ankle damage was detected was 3 (2-3), one patient had evidence of damage at diagnosis. Median (IQR) number of any type of ankle imaging done before the ankle damage was detected was 1 (1-3). The median (IQR) time to start methotrexate from diagnosis was 6 (0 - 29.5) months and median (IQR) number of biologic and synthetic DMARDs used at follow-up were 3.5 (2.2 – 4.0). 7/16 (44%) patients had undergone an orthopaedic surgical procedure for their ankle damage. Conclusion Ankle synovitis at presentation and an extended oligo-articular disease course were common in this cohort of children and young people (CYP) with JIA and ankle damage. Ankle damage is an important challenge in JIA; a substantial number of this cohort ultimately required surgical intervention. There is an urgent need to develop a care pathway designed to improve early recognition and management of evolving ankle joint damage in JIA. Our analysis suggests that attention may need to focus on CYP presenting with ankle synovitis, particularly those who develop a poly-articular disease course, may merit high levels of vigilance with be at particularly high risk. Conflicts of Interest The authors declare no conflicts of interest.

PS02.160: OUTPATIENT FOLLOW-UP IN OESOPHAGO-GASTRIC SURGERY PATIENTS: A SAFE AND COST-EFFECTIVE ALLIED HEALTHCARE PROFESSIONAL MODEL

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 167-167
Author(s):  
Ji Chung Tham ◽  
Amy Wright ◽  
Marilyn Bolter ◽  
Richard Berrisford ◽  
Lee Humphreys ◽  
...  
Keyword(s):  
Vitamin D ◽  
Conflicts Of Interest ◽  
Pancreatic Insufficiency ◽  
Cost Effective ◽  
High Volume ◽  
Nutritional Deficiencies ◽  
Nurse Specialist ◽  
Use Of Resources ◽  
Allied Healthcare

Abstract Background Post-operative follow-up for post oesophago-gastric resection patients are usually conducted by clinicians. Follow-up normally continues for a 5-year period. In high volume tertiary NHS centres, there is an increased demand for outpatient clinician episodes. We have successfully trialled and implemented a model using Allied Healthcare Professionals (AHP); consisting of a Cancer Nurse Specialist (CNS) and Specialist Dietician (SD). We propose that AHP follow-up in the outpatient department is cost-effective and beneficial to patients. Methods An AHP clinic was implemented in our regional tertiary unit in February 2017. All post-operative patients without any on-going complications were eligible to attend the AHP clinic from their second outpatient visit. Data was collected from February 2017 to January 2018. The data was prospectively collected and retrospectively analysed. The AHP follow-up clinic was conducted by a CNS & SD, which runs in parallel with a consultant led clinic. Each patient in the AHP clinic is given an extended 30-minute consultation, compared to a standard 10-minute consultant appointment. This allows for queries to be addressed thoroughly and investigations required to be made. Results During this initial trial period, there were 44 AHP clinics with 197 outpatient consultations; average of 4.5 patients per clinic. There was good outpatient attendance compliance and improved patient satisfaction. In more recent patients, assessment for pancreatic insufficiency, iron, folate, B12 and vitamin D deficiencies were assessed and treated. 27 of 77 (35%) had symptoms of pancreatic insufficiency, 6 of 57 (12%) had low folate, 4 of 52 (7%) had B12 deficiency and 6 of 26 (23%) had vitamin D deficiency. All patients with deficiencies were given supplementation. Conclusion AHP follow-up from their second visit is safe, improves patient contact and satisfaction. Nutritional deficiencies can be detected and treatment commenced by AHPs without detriment to patient outcome. This provides a platform for cost effective use of resources. AHP follow-up increases consultant outpatient episodes available for the hospital trust. In the next phase, the AHPs intend on having 270 patient consultations per year (6 patient consultations per clinic with 45 clinics per year) with a standardised nutritional deficiency assessment. Disclosure All authors have declared no conflicts of interest.

Resolution of symptoms after Heller's cardiomyotomy with DOR fundoplication versus endoscopic balloon dilatation in patients with achalasia Cardia at tertiary care hospital

2021 ◽  
Author(s):  
Shahriyar Ghazanfar ◽  
Sajida Qureshi ◽  
Ali Rasheed ◽  
Fahad Memon ◽  
Mohammad Saeed Quraishy
Keyword(s):  
Balloon Dilatation ◽  
Treatment Success ◽  
Tertiary Care ◽  
Pneumatic Dilatation ◽  
Care Hospital ◽  
Dor Fundoplication ◽  
Achalasia Cardia ◽  
Heller’S Myotomy ◽  
Heller's Myotomy

Objective: The objective was to compare symptoms improvement following Heller's myotomy with DOR fundoplication (HM-DOR) and endoscopic pneumatic dilatation (PD) for the treatment of achalasia cardia at one year follow up. Methods: This prospective comparative study was conducted at department of upper GI and minimally invasive surgery, Civil hospital Karachi from February 2016- January 2019. All patients diagnosed as a case of achalasia cardia on esophageal manometry were included in this study. Subjects were grouped into two treatment groups: Endoscopic Pneumatic Dilatation(PD) and laparoscopic Heller's myotomy with DOR fundoplication (HM-DOR). Results: A total of 42 patients were taken into study, of which 21 patients were randomly assigned in each of the two groups (surgery and endoscopic). Mean age of patients undergoing laparoscopic Heller’s myotomy and endoscopic pneumatic balloon dilatation was 34±8.59 and 37±12.87 years respectively. Treatment success in PD group was 52% (11/21) as compared to HM-DOR group which was 76% (16/21). Post Eckardt scores reduction at 1 year follow up between PD and HM-DOR were statistically significant (p<0.001). Patient satisfaction measured by likert's scale was significantly more in the surgery group. Conclusion: The efficacy of HM appears to be greater than PD for improvement in dysphagia and overall patients satisfaction score over a 1 year follow up period. Keywords: Esophageal achalasia, Heller’s myotomy (HM), Endoscopic pneumatic dilatation (PD). Continuous...

scholarly journals Experience and Technique for Zenker's Diverticulum Per Oral Endoscopic Myotomy: Z-POEM

2020 ◽  
Author(s):  
Eitan Podgaetz ◽  
Vani Konda
Keyword(s):  
Third Space ◽  
Zenker’S Diverticulum ◽  
Complication Rates ◽  
Short Term ◽  
Zenker's Diverticulum ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Invasive Techniques ◽  
Per Oral

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.

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