scholarly journals Feasibility of Using an Led-Probe in Third-Space Endoscopy: A Clinical Study

2020 ◽  
Author(s):  
Oscar Victor Hernández Mondragón ◽  
Raul Antonio Zamarripa Mottu ◽  
Omar Michell Solórzano Pineda ◽  
Raul Antonio Gutierrez Aguilar ◽  
Luis Fernando Garcia Contreras
Keyword(s):  
Clinical Success ◽  
Care Center ◽  
Tertiary Care ◽  
Third Space ◽  
Peroral Endoscopic Myotomy ◽  
Gastric Emptying Scintigraphy ◽  
Submucosal Tunnel ◽  
Average Patient ◽  
Endoscopic Myotomy ◽  
Integrated Relaxation Pressure

Abstract Background and aims: Third-space endoscopy is a novel, safe, and effective method for treating different gastrointestinal conditions. However, several failed endoscopic procedures are attributed to incomplete myotomy. Lighting devices are used to prevent organic injuries. We aimed to investigate the feasibility of using a hand-made LED-probe (LP) in third-space procedures.Patients and Methods: This prospective study was conducted in a tertiary-care center in Mexico between December 2016 and January 2019. We included peroral endoscopic myotomy (POEM) and gastric peroral endoscopic myotomy(G-POEM) procedures. Pseudoachalasia, peptic ulcer, normal gastric emptying scintigraphy (GES) and prepyloric tumors were excluded. LP was used to guide or confirm procedures. Clinical and procedural characteristics were recorded and analyzed.Results: Seventy third-space procedures were included (42POEM,28G-POEM), with an average patient age of 46.7±14.3 and 43.7±10.1 years, respectively. For the POEM and G-POEM groups, respectively, 18/42(42.9%) and 13/28(46.7%) patients were males; median procedure times were 50 (interquartile range[IQR]: 38-71) and 60(IQR: 48-77) min, median LP placement times were 5(IQR: 4-6) and 6(IQR: 5-7) min, mild adverse events occurred in 4(9.4%) and 4(14.2%) of cases, and clinical success at 6 months occurred in 100% and 85.7% of cases. Integrated relaxation pressure (IRP) improved from 27.3±10.8 to 9.5±4.1 mmHg (p<0.001); retention percentage at 4 hours also improved. LP was successfully placed and adequate myotomy confirmed including 14.2% and 17.8% of POEM and G-POEM difficult patients. Conclusions: Using an LP is promising and allows guiding during third-space procedures either for submucosal tunnel creation or myotomy confirmation, with excellent safety and efficacy in clinical practice.

scholarly journals Feasibility of Using an LED-Probe in Third-Space Endoscopy: A Clinical Study

2020 ◽  
Author(s):  
Oscar Victor Hernández Mondragón ◽  
Raul Antonio Zamarripa Mottu ◽  
Omar Michell Solórzano Pineda ◽  
Raul Antonio Gutierrez Aguilar ◽  
Luis Fernando Garcia Contreras
Keyword(s):  
Clinical Success ◽  
Care Center ◽  
Tertiary Care ◽  
Third Space ◽  
Peroral Endoscopic Myotomy ◽  
Gastric Emptying Scintigraphy ◽  
Submucosal Tunnel ◽  
Average Patient ◽  
Endoscopic Myotomy ◽  
Integrated Relaxation Pressure

Abstract Background and aims: Third-space endoscopy is a novel, safe, and effective method for treating different gastrointestinal conditions. However, several failed endoscopic procedures are attributed to incomplete myotomy. Lighting devices are used to prevent organic injuries. We aimed to investigate the feasibility of using a hand-made LED-probe (LP) in third-space procedures. Patients and Methods: This prospective study was conducted in a tertiary-care center in Mexico between December 2016 and January 2019. We included peroral endoscopic myotomy (POEM) and gastric peroral endoscopic myotomy(G-POEM) procedures. Pseudoachalasia, peptic ulcer, normal gastric emptying scintigraphy (GES) and prepyloric tumors were excluded. LP was used to guide or confirm procedures. Clinical and procedural characteristics were recorded and analyzed. Results: Seventy third-space procedures were included (42POEM,28G-POEM), with an average patient age of 46.7±14.3 and 43.7±10.1 years, respectively. For the POEM and G-POEM groups, respectively, 18/42(42.9%) and 13/28(46.7%) patients were males, median procedure times were 50 (interquartile range[IQR]: 38-71) and 60(IQR: 48-77) min, median LP placement times were 5(IQR: 4-6) and 6(IQR: 5-7) min, mild adverse events occurred in 4(9.4%) and 4(14.2%) of cases, and clinical success at 6 months occurred in 100% and 85.7% of cases. Integrated relaxation pressure (IRP) improved from 27.3±10.8 to 9.5±4.1 mmHg (p<0.001); retention percentage at 4 hours also improved. LP was successfully placed and confirmed adequate myotomy including 14.2% and 17.8% of POEM and G-POEM difficult patients. Conclusions: Using an LP is promising and allows guiding during third-space procedures either for submucosal tunnel creation or myotomy confirmation, with excellent safety and efficacy in clinical practice.

scholarly journals Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial

2020 ◽  
Vol 08 (09) ◽  
pp. E1137-E1143
Author(s):  
Yervant Ichkhanian ◽  
Omid Sanaei ◽  
Andrew Canakis ◽  
Kia Vosoughi ◽  
Erik Almazan ◽  
...  
Keyword(s):  
Esophagogastric Junction ◽  
Clinical Success ◽  
Short Form ◽  
Tertiary Care ◽  
Prospective Trial ◽  
Peroral Endoscopic Myotomy ◽  
Outflow Obstruction ◽  
Impedance Planimetry ◽  
Sf 36 ◽  
Endoscopic Myotomy

Abstract Background and study aims Esophagogastric junction outflow obstruction (EGJOO) is a rare esophageal dysmotility disease that is characterized by elevated integrated relaxation pressuse (IRP) with evidence of preserved peristalsis. The role of peroral endoscopic myotomy (POEM) in management of EGJOO is currently unknown. Patients and methods This is a prospective trial conducted in a single US tertiary care center from June 2015 to June 2019. Symptomatic patients, diagnosed with EGJOO on both HRM and endoluminal functional lumen imaging probe (EndoFLIP), who were eligible for POEM were recruited. Primary outcome was clinical success, defined as Eckardt score (ES) ≤ 3, at 6 months post-POEM. Other outcomes included dysphagia score, quality of life as measured by 36-item Short Form health survey scales (SF-36), post-POEM HRM, EndoFLIP, and pH measurements, and adverse events. Results A total of 15 patients (51.8 yr. 9 F) with EGJOO underwent POEM. Pre-POEM mean IRP on HRM and Distensibility index (DI) on EndoFLIP were 24.3 ± 2.2 mmHg and 1.1 ± 0.6 mm2/mmHg, respectively. Clinical success was achieved in 93 % at 6 months post-POEM. There was significant decrease in IRP (-17.6 mmHg) post-POEM. There was significant improvement at 6 months in two of the SF-36 subscales. Ten patients underwent post-POEM pH testing, seven of whom had abnormal DeMeester score. Seven patients underwent EGD evaluation revealing esophagitis in five (2 Los Angeles grade A and 3 grade B). Conclusions POEM offers a high clinical success rate for patients with EGJOO confirmed by impedance planimetry.

Peroral endoscopic myotomy for the treatment of achalasia patients with Roux-en-Y gastric bypass anatomy

Endoscopy ◽  
2018 ◽  
Vol 51 (04) ◽  
pp. 342-345 ◽  
Author(s):  
Omid Sanaei ◽  
Peter Draganov ◽  
Rastislav Kunda ◽  
Dennis Yang ◽  
Mouen Khashab
Keyword(s):  
Gastric Bypass ◽  
Clinical Success ◽  
Length Of Hospital Stay ◽  
Peroral Endoscopic Myotomy ◽  
Tunnel Length ◽  
Submucosal Tunnel ◽  
Eckardt Score ◽  
Exposure Testing ◽  
Endoscopic Myotomy ◽  
The Mean

Abstract Background The outcome of peroral endoscopic myotomy (POEM) in patients with prior Roux-en-Y gastric bypass (RYGB) is not known and some experts have recommended against its performance in this patient population because of the risk of postoperative regurgitation. The aim of this study was to report on the outcomes of POEM in patients with RYGB anatomy. Methods Patients with RYGB anatomy who underwent POEM for the treatment of achalasia at three tertiary centers were included. POEM was performed in standard fashion using the anterior or posterior approach. Clinical response was defined by a decrease in Eckardt score to ≤ 3. Results of esophageal acid exposure testing/pH-impedance and manometric testing after POEM were reported when available. Results A total of 10 achalasia patients with prior RYGB surgery underwent POEM. All procedures were technically successful with anterior myotomy performed in seven patients. The mean submucosal tunnel length and myotomy length were 12.9 cm and 11.1 cm, respectively. The mean procedure time was 72 minutes and mean length of hospital stay was 1.5 days. Clinical success was achieved in all 10 patients with a significant decrease in Eckardt score from 6.5 to 1 (P < 0.001). None of the patients experienced post-procedural regurgitation. Post-procedural pH testing was obtained in six patients and was normal in all of them. Conclusions This study suggests the feasibility, safety, and efficacy of POEM in patients with prior RYGB surgery. The risk of gastroesophageal reflux disease in these patients seems to be minimal after POEM.

scholarly journals Sa1322 OUTCOMES OF PERORAL ENDOSCOPIC MYOTOMY (POEM) AMONG THERAPY-NAIVE PATIENTS WITH ACHALASIA AT A SINGLE TERTIARY CARE CENTER

2020 ◽  
Vol 91 (6) ◽  
pp. AB165-AB166
Author(s):  
Jagpal S. Klair ◽  
Michael Larsen ◽  
Joanna K. Law ◽  
Donald Low ◽  
Richard A. Kozarek ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Peroral Endoscopic Myotomy ◽  
Tertiary Care Center ◽  
Endoscopic Myotomy

scholarly journals The Canadian POEM Experience: The First 50 Patients

2020 ◽  
Author(s):  
Mandip Rai ◽  
Matthew Woo ◽  
Robert Bechara
Keyword(s):  
Adverse Events ◽  
Clinical Success ◽  
Care Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Clinical Success Rate ◽  
Invasive Technique ◽  
Eckardt Score ◽  
Tertiary Center ◽  
Endoscopic Myotomy

Abstract Background and Aims Peroral endoscopic myotomy (POEM) has emerged as a less invasive technique for performing myotomy in patients with achalasia. This study aims to assess the safety and efficacy of POEM in a Canadian tertiary care center. Methods All consecutive patients who underwent POEM between March 2016 and May 2018 at a tertiary center were included. The primary outcome of the study was clinical success rate of POEM defined as a post-POEM Eckardt score ≤3 at ≥3 months. Adverse events were recorded according to the Clavien-Dindo grading system. Results A total of 50 consecutive patients underwent 51 POEM procedures with a mean procedure length of 85.6 ± 29.6 min. Post-POEM Eckardt scores of ≤3 at ≥3 months was achieved in 98% of patients. The incidence of pathologic reflux post-poem was 23%. The median length of hospital stay was 1 day. No major adverse events occurred. Interpretation POEM is a safe and effective procedure for the treatment of achalasia. At a median follow-up of 19.5 months, 98% of patients had sustained clinical response (Eckardt score ≤3).

Peroral endoscopic myotomy in treatment-naïve achalasia patients versus prior treatment failure cases

Endoscopy ◽  
2017 ◽  
Vol 50 (04) ◽  
pp. 358-370 ◽  
Author(s):  
Zaheer Nabi ◽  
Mohan Ramchandani ◽  
Radhika Chavan ◽  
Manu Tandan ◽  
Rakesh Kalapala ◽  
...  
Keyword(s):  
Adverse Events ◽  
Treatment Failure ◽  
Operative Time ◽  
Clinical Success ◽  
Tertiary Care ◽  
Peroral Endoscopic Myotomy ◽  
Prior Treatment ◽  
Naive Group ◽  
Treatment Naïve ◽  
Endoscopic Myotomy

Abstract Background and study aim Peroral endoscopic myotomy (POEM) has emerged as an effective treatment modality for achalasia. Prior treatment may affect the outcomes of subsequent management. In this study, we aimed to compare the safety and efficacy of POEM in treatment-naïve patients vs. those with prior treatment failure (PTF). Patients and methods The data of consecutive patients with achalasia who underwent POEM at a single tertiary care center from January 2013 to November 2016 were analyzed retrospectively. A comparative analysis was performed between treatment-naïve and PTF cases. Technical and clinical success, adverse events, and operative time for POEM were compared between the two groups. Results Overall, 502 patients with achalasia underwent POEM during the study period: 260 patients (51.8 %) in the treatment-naïve group and 242 patients (48.2 %) in the PTF group. The mean operative time was significantly longer in the PTF group compared with the treatment-naïve group (74.9 ± 30.6 vs. 67.0 ± 27.1 minutes; P  = 0.002). On multivariate analysis, type of achalasia, dilated esophagus ( > 6 cm), disease duration, prior treatment, occurrence of adverse events, and type of knife used were significant predictors of operative time. Technical success (98.1 % vs. 97.1 %; P = 0.56) and clinical success (92.4 % vs. 92.5 %; P  = 0.95) were comparable in the treatment-naïve and PTF cases, respectively. Occurrence of gas-related events and mucosotomy were similar in both groups. Elevated DeMeester score was found in 17 /53 patients (32.1 %) in the PTF group and in 11 /44 patients (25.0 %) in the treatment-naïve group (P = 0.50). Conclusion POEM is safe and equally effective for treatment-naïve patients and for those in whom prior treatment has failed. POEM should be considered the treatment of choice in patients in whom prior treatment has failed.

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