scholarly journals Two-Person Technique of Peroral Endoscopic Myotomy for Achalasia with an Advanced Endoscopist and a Thoracic Surgeon: Initial Experience

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Madhusudhan R. Sanaka ◽  
Ramprasad Jegadeesan ◽  
Prashanthi N. Thota ◽  
Udayakumar Navaneethan ◽  
Rocio Lopez ◽  
...  
Keyword(s):  
Peroral Endoscopic Myotomy ◽  
Column Height ◽  
Therapeutic Success ◽  
Delayed Bleeding ◽  
Eckardt Score ◽  
Thoracic Surgeon ◽  
Endoscopic Myotomy ◽  
Barium Esophagogram ◽  
Timed Barium Esophagogram

Background and Aims. We initiated peroral endoscopic myotomy (POEM) utilizing a two-person technique with combination of an advanced endoscopist and a thoracic surgeon with complementary skills. Our aim was to determine the feasibility and outcomes in initial 20 patients. Methods. In this observational study, main outcomes measured were therapeutic success in relieving symptoms (Eckardt score < 3), decrease in lower esophageal sphincter (LES) pressures, improvement in emptying on timed barium esophagogram (TBE), and complications.Results. POEM was successful in all 20 patients with a mean operative time of140.1+32.9minutes. Eckardt symptom scores decreased significantly at two-month follow-up (6.4+2.9versus0.25+0.45,p<0.001). Both basal and residual LES pressures decreased significantly (28.2+14.1 mmHg versus12.8+6.3and22.4+11.3versus6.3+3.4 mmHg,p=0.025and <0.001, resp.). Barium column height at 5 minutes on TBE reduced from6.8+4.9 cm to2.3+2.9 cm (p=0.05). Two patients (10%) had mucosal perforations and one had delayed bleeding (5%).Conclusions.Two-person technique of POEM with combination of an advanced endoscopist and a thoracic surgeon is highly successful with low risk of complications.

Peroral endoscopic myotomy versus pneumatic dilation – result from a retrospective study with 1-year follow-up

2019 ◽  
Vol 57 (03) ◽  
pp. 304-311 ◽  
Author(s):  
Zhongqing Zheng ◽  
Chunshan Zhao ◽  
Shuai Su ◽  
Xiaofei Fan ◽  
Wei Zhao ◽  
...  
Keyword(s):  
Functional Data ◽  
Peroral Endoscopic Myotomy ◽  
Type I ◽  
Exact Test ◽  
Fisher's Exact Test ◽  
Eckardt Score ◽  
Reflux Symptoms ◽  
Fisher’S Exact Test ◽  
Endoscopic Myotomy

Abstract Background and aims On the basis of lesser rates of major adverse events and a short-term efficacy as Heller’s myotomy, there is a growing enthusiasm in favor of peroral endoscopic myotomy (POEM), whereas study comparing POEM and pneumatic dilatation (PD) is quite rare. The aim of this study was to evaluate the efficacy of POEM and PD in Chinese achalasia patients in a retrospectively designed study. Methods Patients with achalasia, who underwent either PD (n = 26) or POEM (n = 40) were retrospectively recruited from September 2010 through March 2016 at a single tertiary center. During the 1-year follow-up, clinical outcome and functional data of lower esophageal sphincter (LES) were recruited. Clinical symptoms were assessed by use of the Eckardt score. The primary outcome was therapeutic success (Eckardt score ≤ 3). Functional data of LES (4-second integrated relaxation pressure [4s-IRP], LES relax rate, and LESP) at baseline and 1 month after treatment were also evaluated. Data was analyzed by SPSS 13.0 version using a significance level of p < 0.05. Results The success rates were 24/26 (92.31 %), 25/26 (96.15 %), and 24/26 (92.31 %), respectively, with POEM, as compared with 35/40 (87.50 %), 29/40 (72.50 %), and 23/40 (57.50 %), respectively, with PD, 1 month, 3 months, and 1 year after treatment. Statistically significant difference was observed between the 2 therapies (at 3 months, Fisher’s exact test, p = 0.01; at 1 year, Fisher’s exact test, p < 0.0001). Compared with PD, the Eckardt score was lower with POEM 1 month, 3 months, and 1 year after treatment. More patients in POEM group reported gastroesophageal reflux symptoms (after 3 months 7/26 (26.92 %) vs. 2/40 (5.00 %), Fisher’s exact test, p = 0.01; after 1 year 6/26 (19.23 %) vs. 1/35 (2.86 %), Fisher’s exact test, p = 0.02). The postoperative 4s-IRP and LESP were both lower with POEM than with PD, respectively. Type I achalasia had a better response with POEM than with PD. Conclusion In this retrospective analysis with 1-year follow-up, POEM presents with a higher success rate and more reflux symptoms compared with PD. Change on LES function after treatment may explain the outcome in part. Type I achalasia may respond better to therapies compared with type II.

scholarly journals Single-session endoscopic fundoplication after peroral endoscopic myotomy (POEM+F) for prevention of post gastroesophageal reflux – 1-year follow-up study

Endoscopy ◽  
2020 ◽  
Author(s):  
Amol Bapaye ◽  
Parag Dashatwar ◽  
Siddharth Dharamsi ◽  
Rajendra Pujari ◽  
Harshal P Gadhikar
Keyword(s):  
Gastroesophageal Reflux ◽  
Peroral Endoscopic Myotomy ◽  
P Value ◽  
Prior Therapy ◽  
Eckardt Score ◽  
Single Center Study ◽  
Endoscopic Myotomy ◽  
Endoscopic Fundoplication ◽  
One Year

Background and Aim Peroral endoscopic myotomy (POEM) is an established treatment for achalasia cardia (AC), however post-POEM gastroesophageal reflux (GER) remains a significant problem. Concomitant endoscopic fundoplication following POEM (POEM+F) was recently described to reduce post-POEM GER. This single-center study reports medium-term outcomes of POEM+F. Patients and Methods Retrospective analysis of prospectively maintained database of patients undergoing POEM+F. Abstracted data – demographics, achalasia type, pre-POEM Eckardt score (ES), prior therapy, follow-up. Follow-up was 3-monthly for one-year. Follow-up assessments included post-POEM ES, GerdQ score, EGD – wrap integrity and esophagitis, and pH studies. GER was defined according to Lyon consensus. Data was recorded as mean (SD) or median (IQR), P-value < 0.05 was considered statistically significant. Results 25 patients underwent POEM+F, mean age (SD) – 40.13 (13.66) years, 12 females. POEM+F was technically successful in 23/25 (92%). Significant dysphagia improvement was seen in all 25 (mean [SD] pre- and post-POEM ES 8.21 [1.08] and 0.1 [0.3] respectively, p < 0.05). Mean total procedure and fundoplication time (SD) – 115.6 (27.2) and 46.7 (12.4) minutes respectively. Time reduced significantly after initial 5 cases. Median follow-up was 12-months (IQR 9 – 13). Intact wrap was seen in 19/23 (82.6%). GER (abnormal EAET) was seen in 2/18 (11.1%); one reported GerdQ > 8. Borderline GER (asymptomatic grade A esophagitis, normal EAET) was identified in 4/22 (18.1%). Two (8%) minor delayed adverse events required no intervention. Conclusions POEM+F is safe and reproducible. At 12-months follow-up, incidence of post-POEM+F GER was low and acceptable.

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.

Management of Patients after Failed Peroral Endoscopic Myotomy: a Multicenter Study

Endoscopy ◽  
2020 ◽  
Author(s):  
Yervant Ichkhanian ◽  
Daniella Assis ◽  
Pietro Familiari ◽  
Michael B Ujiki ◽  
Baily Su ◽  
...  
Keyword(s):  
Clinical Success ◽  
Management Strategies ◽  
Laparoscopic Heller Myotomy ◽  
Peroral Endoscopic Myotomy ◽  
Pneumatic Dilation ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
Excellent Safety Profile ◽  
International Multicenter

Background and Aims: Although Peroral Endoscopic Myotomy (POEM) is highly effective for the management of achalasia, clinical failures may occur. The optimal management of patients who fail POEM is not well known. This study aims to compare the outcomes of different management strategies in patients who had failed POEM. Patients and Methods: This is an international, multicenter, retrospective study at 16 tertiary centers between 1/2012 and 11/2019. All patients who underwent POEM and experienced persistent or recurrent symptoms (Eckardt score (ES) > 3) were included. The primary outcome was to compare the rate of clinical success (ES ≤ 3) between different management strategies. Results: A total of 99 patients (50 (50.5%) males, mean age 51.4 (16.2) yrs.) experienced clinical failure during the study period with a mean ES of 5.5 (0.2). A total of 29 (32.2%) patients were managed conservatively and 70 (71%) underwent re-treatment [repeat POEM 33 (33%), pneumatic dilation (PD) 30 (30%), and laparoscopic Heller myotomy (LHM) 7 (7.1%)]. During a median follow-up of 10 (IQR: 3-20) months, clinical success was highest in patients who underwent repeat POEM (25/33 (76%), mean ES 2.1 (2.1)), followed by PD (18/30 (60%), mean ES 2.8 (2.3)), and LHM (2/7 (29%), 4 (1.8)) (p=0.12). A total of 11 (37.9%, mean ES 4 (1.8)) patients in the conservative achieved clinical success. Conclusion: This study comprehensively assessed an international cohort of patients who underwent management of failed POEM. Repeat POEM and PD achieved acceptable clinical success with excellent safety profile.

Is integrated relaxation pressure a promising predictor of effectiveness of peroral endoscopic myotomy for achalasia?

2017 ◽  
Vol 56 (02) ◽  
pp. 111-116
Author(s):  
Hong Jin ◽  
Wei Zhao ◽  
Lili Zhang ◽  
Zhongqing Zheng ◽  
Tao Wang ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Peroral Endoscopic Myotomy ◽  
Symptom Improvement ◽  
Symptom Duration ◽  
Type I ◽  
Type Ii ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
Integrated Relaxation Pressure

Abstract Background Peroral endoscopic myotomy (POEM), first introduced in 2010, appears to be an effective therapy with few complications. This study aimed to find an optimal predictor of POEM outcome in achalasia. Methods We retrospectively assessed 89 patients diagnosed with achalasia who underwent POEM in General Hospital of Tianjin Medical University, from September 2012 to March 2015. Associations of Eckardt score with symptom duration, lower esophageal resting pressure, 4-second integrated relaxation pressure (4s-IRP), and maximum esophageal diameter were assessed before POEM. The most relevant data were progressively grouped to compare symptom improvement after POEM in 85 patients at 1 year follow-up. Results The most significant correlation was found between 4s-IRP and Eckardt score (p < 0.01). The 85 achalasia patients (1-year follow-up after POEM) were divided into 3 groups according to 4s-IRP values; patients with mean 4s-IRP of 25 – 34 mmHg exhibited significantly greater improvement of clinical symptoms compared with the remaining 2 groups (p < 0.05). No significant postoperative difference was noted between types I and II in all patients according to Chicago classification criteria. The 40 patients with 4s-IRP of 25 – 34 mmHg were further divided into 2 subgroups; the 28 patients with type II achalasia responded better to POEM than the 12 with type I disease (p < 0.05). Conclusions 4s-IRP, together with achalasia subtypes, may predict treatment outcome after POEM. Patients with type II achalasia and 4s-IRP of 25 – 34 mmHg may experience more satisfactory remission after POEM.

Long-term quality of life after peroral endoscopic myotomy remains compromised in patients with achalasia type III

Endoscopy ◽  
2017 ◽  
Vol 49 (12) ◽  
pp. 1209-1218 ◽  
Author(s):  
Oscar Hernández Mondragón ◽  
Marina González Martinez ◽  
Juan Blancas Valencia ◽  
Maria Hernandez Reyes ◽  
Omar Solórzano Pineda ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Logistic Regression Analysis ◽  
Peroral Endoscopic Myotomy ◽  
Type Iii ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
Type Iii Achalasia

Abstract Background and study aims Peroral endoscopic myotomy (POEM) is an excellent endoscopic treatment for achalasia. Clinical and manometric parameters are used for evaluation and follow-up. However, clinical success does not guarantee high quality of life (QoL) scores, generating doubts about their direct relationship. We aimed to evaluate QoL scores before and after POEM at medium and long term, to evaluate differences between achalasia subtypes and find which factors related to low QoL scores. Patients and methods Achalasia-confirmed patients undergoing POEM between February 2012 and November 2016. and completing at least 1 year of follow-up, were included. Assessment before and at 1, 6, 12, 24, 36 and 48 months after POEM employed manometry, barium series, Eckardt score, and the AE-18 health-related QoL scale. Demographic, clinical, and procedure characteristics were documented, with comparisons between subgroups. Multiple logistic regression analysis was done. Results 65 of 88 patients were included (38 women, 27 men; median age 47 years, interquartile range [IQR] 20 – 81), and 50 (76.9 %) completed 4 years of follow-up. Eckardt score improved (median, preprocedure 10 vs. post-procedure 2; P = 0.002) and this persisted. There was initial improvement in median integrated relaxation pressure (IRP) (29.4 mmHg [16 – 55] vs. 10.3 mmHg [3 – 18]; P = 0.000) and median QoL scores (40 vs. 68 at 1 month; P = 0.002); however IRP increased and QoL scores decreased. Men with confirmed type III achalasia had low QoL scores. Conclusions All patients had significant clinical improvement after POEM, with medium- to long-term persistence. Though quality of life and IRP initially improved, they deteriorated in the long term. Male sex and type III achalasia seem to be associated with low QoL scores.

The effect of prior treatment on clinical outcomes in patients with achalasia undergoing peroral endoscopic myotomy

Endoscopy ◽  
2018 ◽  
Vol 51 (04) ◽  
pp. 307-316 ◽  
Author(s):  
Zu-Qiang Liu ◽  
Quan-Lin Li ◽  
Wei-Feng Chen ◽  
Xiao-Cen Zhang ◽  
Qiu-Ning Wu ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Treatment ◽  
Cox Regression ◽  
Peroral Endoscopic Myotomy ◽  
Prior Treatment ◽  
Clinical Failure ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
Major Adverse Events

Abstract Background Peroral endoscopic myotomy (POEM) is a treatment option for patients with previous surgical or endoscopic treatment. We aimed to evaluate the influence of prior treatment on perioperative and follow-up outcomes in patients undergoing POEM. Methods From August 2010 to December 2014, a total of 1384 patients with achalasia underwent POEM at our center. We retrospectively reviewed 849 patients who completed follow-up. Patients with an Eckardt score ≥ 4 after POEM were considered to have a clinical failure. We compared variables between patients with and without prior treatment. We analyzed risk factors for perioperative major adverse events, and clinical reflux and failure during follow-up.  Results 245 patients (28.9 %) had undergone prior treatment, and 34 patients (4.0 %) experienced a major adverse event associated with the POEM procedure. During a median follow-up of 23 months (range 1 – 71), clinical reflux occurred in 203 patients (23.9 %) and clinical failure was recorded for 94 patients (11.1 %). Patients with prior treatment had a longer procedure duration (P = 0.001) and longer hospital stay after POEM (P = 0.001). Prior treatment was not an independent risk factor for major adverse events or clinical reflux (odds ratio [OR] 1.19, P = 0.65; OR 1.26, P = 0.19; logistic regression), but it did increase the rate of clinical failure during follow-up (hazard ratio 1.90, P = 0.002; Cox regression). Conclusions POEM was performed safely with a low rate of major adverse events in patients with achalasia who had undergone prior surgical or endoscopic treatment. However, prior treatment increased the risk of clinical failure after POEM.

scholarly journals Open peroral endoscopic myotomy for the treatment of achalasia: a case series of 82 cases

2019 ◽  
Vol 32 (10) ◽  
pp. 1-7 ◽  
Author(s):  
W Liu ◽  
X-H Zeng ◽  
X-L Yuan ◽  
C-H Li ◽  
C-C Wu ◽  
...  
Keyword(s):  
Adverse Events ◽  
Treatment Success ◽  
Case Series ◽  
Mucosal Injury ◽  
Peroral Endoscopic Myotomy ◽  
Submucosal Tunnel ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
Submucosal Fibrosis

SUMMARY During peroral endoscopic myotomy (POEM), creation of the tunnel is highly technically demanding and mucosal injury is one of the most common potential complications. We explored a method without a submucosal tunnel, which we call open peroral endoscopic myotomy (O-POEM). This study aimed to assess the feasibility and safety of O-POEM. O-POEM was performed on 82 patients with achalasia. Treatment success was defined as an Eckardt score of less than or equal to 3 after the myotomy. Adverse events including operative and postoperative adverse events were recorded. Treatment success and procedure-related adverse events were analyzed. After a median follow-up of 18 months (range: 6–26 months), the treatment success (Eckhart score ≤3) was achieved in 96.3% of cases (mean score pre- vs. post-treatment (7.4 vs. 1.8); P &lt; 0.001) with a recurrence of 3 cases. Ten patients (12.2%) had adverse events consisting of 2 cases of mediastinitis, 1 case of post-O-POEM bleeding, 1 case of subcutaneous emphysema, 6 cases of pleural effusion. Two cases of mediastinitis required intraprocedural drainage, and other patients were managed by endoscopy and conservative medical treatment. There were no deaths. No patients required surgical conversion. Clinical reflux occurred in 15.9% of patients (13/82). O-POEM was reliable and effective for the treatment of achalasia. In addition, O-POEM might be a better option for patients with severe submucosal fibrosis.

Feasibility of the peroral endoscopic myotomy (POEM) procedure with a new small-caliber endoscope (thin-POEM) in patients with achalasia

Endoscopy ◽  
2019 ◽  
Vol 51 (04) ◽  
pp. 350-354 ◽  
Author(s):  
Oscar Hernandez Mondragón ◽  
Marina González Martínez ◽  
Omar Solórzano Pineda ◽  
Juan Blancas Valencia ◽  
María Hernández Reyes
Keyword(s):  
Ph Monitoring ◽  
Peroral Endoscopic Myotomy ◽  
Eckardt Score ◽  
Barium Esophagram ◽  
Previously Treated Patients ◽  
Previously Treated ◽  
Endoscopic Myotomy ◽  
Integrated Relaxation Pressure ◽  
Closure Method

Abstract Background Peroral endoscopic myotomy (POEM) is a recognized technique for patients with achalasia. We aimed to evaluate the feasibility of using a small-caliber endoscope (thin-POEM) to perform POEM in patients with achalasia. Methods Naïve or previously treated patients were included between February 2016 and April 2018. A small-caliber (5.9 mm) nasoendoscope was used, with a modified closure method using cyanoacrylate. Strict follow-up was performed. Results 45 patients were included, aged 45.5 years (interquartile range [IQR] 22 – 69); 53 % (24/45) had type II achalasia. Median total time for thin-POEM was 54 minutes (IQR 37 – 77) and median myotomy length was 13.5 cm (IQR 6 – 20). Results pre-procedure and 3 months post were Eckardt score 10 vs. 1 (P < 0.001), integrated relaxation pressure (IRP) 25.3 vs. 8.5 mmHg (P < 0.001), and timed barium esophagram (TBE) 100 % severely delayed vs. 86 % normal (P < 0.001), respectively. Type III patients had the longest thin-POEM times (median 58 minutes [IQR 52 – 77]). Reflux was confirmed at 3 months clinically in 17 % of patients, endoscopically in 20 %, and on pH monitoring in 53 %. At 6 months and 12 months, 40 % and 33 % of patients remained positive on pH monitoring and were medically managed. Conclusions Thin-POEM seems to be a safe, effective, and efficient procedure for POEM in patients with achalasia, with good short-term follow-up results.

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