scholarly journals Peroral Endoscopic Myotomy for the Treatment of Achalasia: An Analysis

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Dennis Yang ◽  
Mihir S. Wagh
Keyword(s):  
Peroral Endoscopic Myotomy ◽  
Treatment Modalities ◽  
Short Term ◽  
Future Directions ◽  
Invasive Approach ◽  
Resting Pressure ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter ◽  
Low Incidence

Achalasia is a motility disorder of the esophagus, characterized by aperistalsis of the esophageal body and incomplete relaxation of the lower esophageal sphincter (LES). Treatment of achalasia is currently aimed at decreasing the resting pressure in the LES. Peroral endoscopic myotomy (POEM) is an emerging novel endoscopic procedure for the treatment of achalasia with initial data suggesting an acceptable safety profile, excellent short-term symptom resolution, low incidence of postprocedural gastroesophageal reflux (GER), and improvement in manometric outcomes. Further prospective randomized trials are required to evaluate the long-term effectiveness of this promising technique compared to other treatment modalities for achalasia. In this review we outline the technical aspects of POEM, summarize the available data on safety and outcomes, and suggest future directions for further advancement of this minimally invasive approach for the treatment of achalasia.

scholarly journals Achalasia: From Bench to Peroral Endoscopic Myotomy

2016 ◽  
Vol 34 (5) ◽  
pp. 476-482 ◽  
Author(s):  
Guy E. Boeckxstaens
Keyword(s):  
Laparoscopic Heller Myotomy ◽  
Peroral Endoscopic Myotomy ◽  
Enteric Neurons ◽  
Treatment Modalities ◽  
Success Rates ◽  
Esophageal Motility Disorder ◽  
Autoimmune Reaction ◽  
High Resolution Manometry ◽  
Endoscopic Myotomy ◽  
Low Incidence

Achalasia is a primary esophageal motility disorder with an estimated annual incidence of 1 per 100,000 persons. It is characterized by the absence of esophageal peristalsis and failure of the lower esophageal sphincter (LES) to relax upon swallowing, resulting in progressively severe dysphagia for solids and liquids, regurgitation, aspiration, chest pain and weight loss. Achalasia results from a loss of enteric neurons, most likely due to an autoimmune reaction in patients with a particular immunogenetic background. To date, 3 manometric subtypes have been identified based on high resolution manometry. To what extent these subtypes also indicate differences in underlying pathophysiological mechanisms is however unclear. As achalasia cannot be cured, treatment is confined to disruption of the LES to improve bolus passage and thereby relieving symptoms. The 2 most commonly used treatment modalities available for this purpose include pneumodilation and laparoscopic Heller myotomy. Both treatments have been shown repeatedly to be successful; however, success rates decline in time, most likely due to progression of the disease. A recent European randomized trial provides objective data indicating that both treatments are equally effective. In view of these data and the low incidence of the disease, the choice between these 2 treatments should be based on the expertise and experience available. Recently, excellent short-term success rates have been reported with a new endoscopic technique, that is, peroral endoscopic myotomy. However, longer follow-up data are absolutely needed before accepting this technique as a new treatment option for achalasia in clinical practice.

Peripherally Inserted Central Catheter Lines in the Behavioral Health Client: A Perspective

2006 ◽  
Vol 11 (3) ◽  
pp. 154-156
Author(s):  
Vera Deacon ◽  
Susan Oliver
Keyword(s):  
Behavioral Health ◽  
Chemotherapeutic Agents ◽  
Treatment Modalities ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Short Term ◽  
Hyperosmolar Solutions ◽  
Central Catheters ◽  
Indications For Use

Abstract Peripherally inserted central catheters (PICCs) are used in many different patient populations. The indications for use vary and include infusions of hyperalimentation, chemotherapeutic agents, hyperosmolar solutions, antibiotics, or long-term rehydration. However, on occasion, there are clients who do not fit the typical criteria for PICC insertion. This includes, but is not limited to, those individuals who are receiving frequent intravenous (IV) “sticks” or even short-term infusions of irritating drugs. The behavioral health client is one who may not be the typical PICC or IV patient but who may benefit from the placement of a PICC for certain treatment modalities.

scholarly journals Survival Kit or Lessons for Life? Future Directions for Preservice Teacher Education from the Perceptions of Newer Teachers

2006 ◽  
Vol 1 (1) ◽  
Author(s):  
Larry Glassford ◽  
Noel Hurley
Keyword(s):  
Teacher Education ◽  
Preservice Teacher ◽  
Teacher Candidates ◽  
Secondary School Teachers ◽  
Preservice Teacher Education ◽  
School Teachers ◽  
Short Term ◽  
Future Directions ◽  
Preservice Program

Recent literature, supported by a survey of secondary school teachers in southwestern Ontario, Canada, indicates that preservice teacher education does not adequately prepare graduating teacher candidates to thrive in a profession that is ironically, driven by change. Attempts at reform have focused on the basic aspects of the typical preservice program: foundations, curriculum methods and field experience. The results have been decidedly discouraging. Positive improvement will hinge both on a recognition by teacher-education institutions, of the inevitable compromise between short-term necessity and long-term vision, and on their willingness to implement, carefully and constructively, promising innovations such as action research and centers of pedagogy.

Tu1204 Peroral Endoscopic Myotomy (Poem) in Patients With or Without Prior Heller Myotomy: Comparing Long-Term Outcomes in a Large Us Single Center Cohort

2017 ◽  
Vol 85 (5) ◽  
pp. AB581
Author(s):  
Stavros N. Stavropoulos ◽  
Xiaocen Zhang ◽  
Rani J. Modayil ◽  
Krishna C. Gurram ◽  
Collin E. Brathwaite ◽  
...  
Keyword(s):  
Heller Myotomy ◽  
Peroral Endoscopic Myotomy ◽  
Single Center ◽  
Long Term Outcomes ◽  
Endoscopic Myotomy

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.

Effects of Peroral Endoscopic Myotomy on Esophageal Function in the Treatment of Achalasia

2020 ◽  
pp. 155335062091313
Author(s):  
Bai Cang Zou ◽  
Li Zhang ◽  
Bin Qin ◽  
Shen Hao Wang ◽  
Yan Cheng ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Clinical Symptoms ◽  
Operation Time ◽  
Peroral Endoscopic Myotomy ◽  
Esophageal Stent ◽  
Sphincter Pressure ◽  
Esophageal Function ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Peroral endoscopic myotomy (POEM) is a new technique to treat achalasia, but the effects on esophageal motor function and structure are still unclear. This study aimed to examine the esophageal function and anatomical changes of patients with achalasia treated with POEM. This was a retrospective study of 43 patients with achalasia treated with POEM between January 2013 and January 2016 at the Second Affiliated Hospital of Xi’an Jiaotong University. The patients were grouped as previous treatments for achalasia (n = 19) versus no previous treatment (n = 24). Surgical success (defined as Eckardt score ≤3 points or decreased by >3 points compared with baseline), recurrence, and reintervention were analyzed. Three patients (7.0%) were Eckardt grade I, 16 (37.2%) were grade II, and 24 (55.8%) were grade III. Operation time was 35 to 150 (median = 49) minutes. Both groups showed improvements in the Eckardt score after surgery (both P < .001), without a difference between the 2 groups ( P = .749). The maximal mean diameter of the esophagus was reduced, and the lower esophageal sphincter pressure was improved after surgery (both groups, all P < .001), without difference between the 2 groups (all P > .05). One case of failure was probably due to the presence of an esophageal stent. POEM has a high success rate and is possibly unaffected by previous treatments, except maybe stent implantation. Clinical symptoms of achalasia are significantly relieved by POEM; the function of the esophageal sphincter and the esophagus structure are improved. Previous esophageal stent implantation could increase failure likelihood, but this will have to be confirmed.

Short-term safety and efficacy of peroral endoscopic myotomy for the treatment of achalasia in children

2019 ◽  
Vol 55 (2) ◽  
pp. 159-168 ◽  
Author(s):  
Zuqiang Liu ◽  
Yun Wang ◽  
Ying Fang ◽  
Ying Huang ◽  
Hongbin Yang ◽  
...  
Keyword(s):  
Peroral Endoscopic Myotomy ◽  
Short Term ◽  
Safety And Efficacy ◽  
Endoscopic Myotomy
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