Anesthetic management and associated complications of peroral endoscopic myotomy: A case series

Abstract Introduction Laparoscopic fundoplication is the treatment of severe and refractory gastroesophageal reflux disease (GERD). It induces dysphagia in 5 % – 10 % owing to a tight valve ± esophageal motility disorders (EMD), with challenging management. We assessed the first case series assessing peroral endoscopic myotomy (POEM) in such a situation. Methods A retrospective case series including eight patients with severe dysphagia after laparoscopic fundoplication who were treated by POEM. They were assessed clinically by Eckardt and Mellow – Pinkas dysphagia scores, and by high resolution manometry (HRM). The procedure was a regular esophageal POEM, mainly posterior, including a myotomy of the wrap. The objectives were to evaluate the clinical efficacy, technical difficulties, and complications of this approach. Results HRM showed aperistalsis in 6 /8 patients and raised lower esophageal sphincter (LES) pressure in 5 /8. The median preoperative Eckardt and dysphagia scores were 5 and 3.5, respectively. The procedure was completed in 7 /8 patients, with a clinical efficacy rate (normalization of both scores) of 75 % (6 /8). Although the submucosa seemed more fibrotic and vascularized, no severe complications occurred. Conclusion POEM is a newly described therapeutic option to consider for managing dysphagia due to EMD after laparoscopic fundoplication.

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Peroral endoscopic myotomy—initial experience with anesthetic management of 24 procedures and systematic review

Anesthesia Essays and Researches ◽

10.4103/0259-1162.171462 ◽

2016 ◽

Vol 10 (2) ◽

pp. 297 ◽

Cited By ~ 6

Author(s):

Basavana Goudra ◽

PreetMohinder Singh ◽

Gowri Gouda ◽

AshishC Sinha

Keyword(s):

Systematic Review ◽

Anesthetic Management ◽

Peroral Endoscopic Myotomy ◽

Initial Experience ◽

Endoscopic Myotomy

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Mo1016 - Peroral Endoscopic Myotomy (POEM): A Prospective Case Series of Eighty Patients for Treatment of Achalasia

Gastroenterology ◽

10.1016/s0016-5085(18)34329-4 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-1323

Author(s):

Aman B. Ali ◽

Vishwanath Chegireddy ◽

Dmitry Zavlin ◽

Joseph J. Nguyen-Lee ◽

Nabil Tariq ◽

...

Keyword(s):

Case Series ◽

Peroral Endoscopic Myotomy ◽

Endoscopic Myotomy ◽

Prospective Case Series

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Su1510 PerOral Endoscopic Myotomy (POEM) for Achalasia: Pilot Case Series of a Western Referral Center

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2013.03.1163 ◽

2013 ◽

Vol 77 (5) ◽

pp. AB351 ◽

Cited By ~ 3

Author(s):

Jean Pierre Charton ◽

Brigitte Schumacher ◽

Thomas Toermer ◽

Horst Neuhaus

Keyword(s):

Case Series ◽

Peroral Endoscopic Myotomy ◽

Referral Center ◽

Endoscopic Myotomy

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Su1412 GASTRIC PERORAL ENDOSCOPIC MYOTOMY (G-POEM) IN THE TREATMENT OF REFRACTORY GASTROPARESIS: CASE SERIES AND LITERATURE REVIEW

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2019.03.538 ◽

2019 ◽

Vol 89 (6) ◽

pp. AB371

Author(s):

Alberto M. da Ponte ◽

Vitor M. Sagae ◽

Flavio H. Morita ◽

Carolina O. Matsubayashi ◽

Mauricio K. Minata ◽

...

Keyword(s):

Literature Review ◽

Case Series ◽

Peroral Endoscopic Myotomy ◽

Endoscopic Myotomy

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Anesthesia for peroral endoscopic myotomy: A retrospective case series

Journal of Anaesthesiology Clinical Pharmacology ◽

10.4103/0970-9185.188829 ◽

2016 ◽

Vol 32 (3) ◽

pp. 379 ◽

Cited By ~ 5

Author(s):

Nithin Jayan ◽

JayaSusan Jacob ◽

Mohan Mathew ◽

RoyJoy Mukkada

Keyword(s):

Case Series ◽

Peroral Endoscopic Myotomy ◽

Retrospective Case ◽

Retrospective Case Series ◽

Endoscopic Myotomy

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Transoral Incisionless fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal

Endoscopy International Open ◽

10.1055/a-0584-6802 ◽

2018 ◽

Vol 06 (05) ◽

pp. E549-E552 ◽

Cited By ~ 17

Author(s):

Amy Tyberg ◽

Anthony Choi ◽

Monica Gaidhane ◽

Michel Kahaleh

Keyword(s):

Adverse Events ◽

Case Series ◽

Acid Exposure ◽

Peroral Endoscopic Myotomy ◽

Technical Success ◽

Post Procedure ◽

First Case ◽

Endoscopic Myotomy ◽

Small Cohort

Abstract Introduction Increased esophageal acid exposure is seen in a large percentage of patients with achalasia who undergo peroral endoscopic myotomy (POEM). Endoscopic transoral fundoplication (TIF) is a novel endoscopic technique for the management of patients with chronic gastroesophageal reflux (GERD). We present the first case series evaluating the role of TIF post-POEM. Methods Consecutive patients 18 years or older from our academic institution who underwent a POEM procedure and subsequently underwent TIF for symptomatic reflux or regurgitation between December 2014 and June 2017 were included. The primary outcome was discontinuation of proton-pump inhibitor (PPI) use and healing of esophagitis (when initially present) on post-procedure esophagogastroduodenoscopy (EGD). Technical success was defined as successful completion of the endoscopic fundoplication. Adverse events (AEs) were recorded for all patients. Results Five patients were included (60 % male, average age 55 ± 14 years). Technical success was achieved in 100 % of patients. Discontinuation of PPI use was achieved in 5/5 patients (100 %). Three patients had esophagitis pre-procedure and all were noted to have resolution of inflammation on post-procedure EGD. No adverse events were noted. Mean follow-up time was 27 months (range 5 – 34 months). Conclusion TIF post-POEM appears feasible, safe, and efficacious in improving symptoms and esophagitis, decreasing long-term risks of acid exposure, and decreasing risks of long-term PPI use in patients post-POEM in this small cohort of patients. Larger studies are needed to confirm these initial findings.

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An international study on the use of peroral endoscopic myotomy (POEM) in the management of esophageal diverticula: the first multicenter D-POEM experience

Endoscopy ◽

10.1055/a-0759-1428 ◽

2018 ◽

Vol 51 (04) ◽

pp. 346-349 ◽

Cited By ~ 22

Author(s):

Juliana Yang ◽

Xianhui Zeng ◽

Xianglei Yuan ◽

Kenneth Chang ◽

Omid Sanaei ◽

...

Keyword(s):

Clinical Success ◽

Case Series ◽

Peroral Endoscopic Myotomy ◽

Endoscopic Management ◽

Distinct Advantage ◽

Technical Success Rate ◽

Dysphagia Score ◽

Esophageal Diverticula ◽

First Case ◽

Endoscopic Myotomy

Abstract Background The aim of this study is to report a novel, multicenter experience with the diverticular peroral endoscopic myotomy (D-POEM) technique in the management of esophageal diverticula. Methods This is a multicenter, international, retrospective study involving three centers. D-POEM was performed using the principles of submucosal endoscopy. Results A total of 11 patients with an esophageal diverticulum (Zenker’s 7, mid-esophagus 1, epiphrenic 3) were included. The mean size of the esophageal diverticula was 34.5 mm. The overall technical success rate of D-POEM was 90.9 %, with a mean procedure time of 63.2 minutes. There were no adverse events. Clinical success was achieved in 100 % (10 /10), with a decrease in mean dysphagia score from 2.7 to 0.1 (P < 0.001) during a median follow-up of 145 days (interquartile range 126 – 273). Conclusion Endoscopic management of esophageal diverticula using the novel technique of D-POEM appears promising. This first case series on D-POEM suggests that the procedure is feasible, safe, and effective in the management of esophageal diverticula. D-POEM offers the distinct advantage of ensuring a complete septotomy. Larger studies are needed to confirm these intriguing results.

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Peroral endoscopic myotomy using FlushKnife BT: a single-center series

Endoscopy International Open ◽

10.1055/s-0043-111721 ◽

2017 ◽

Vol 05 (07) ◽

pp. E663-E669 ◽

Cited By ~ 6

Author(s):

Shinwa Tanaka ◽

Takashi Toyonaga ◽

Fumiaki Kawara ◽

Ian Grimm ◽

Namiko Hoshi ◽

...

Keyword(s):

Case Series ◽

Operation Time ◽

Acid Reflux ◽

Median Number ◽

Peroral Endoscopic Myotomy ◽

Esophageal Spasm ◽

Vessel Sealing ◽

Endoscopic Myotomy ◽

Needle Knife ◽

Median Operation Time

Abstract Background and study aims Peroral endoscopic myotomy (POEM) is an evolving new treatment strategy for achalasia. Although several kinds of electrosurgical knives have been used in performing POEM, the best device has yet to be determined. The FlushKnife BT is a waterjet-emitting short needle-knife with a small ball tip (BT) that offers the potential to perform all aspects of POEM with a single device. In this study, we evaluated the safety and efficiency of the FlushKnife BT for POEM. Patients and methods A total of 54 consecutive patients with achalasia and other spastic esophageal motility disorders, such as jackhammer esophagus or distal esophageal spasm, who underwent POEM between January 2016 and August 2016, were included in this retrospective study. Results The median operation time was 73.0 minutes (range 39 – 184 minutes). All procedures were completed using only the FlushKnife BT without changing to any other electrosurgical instrument. The median number of additional submucosal injections with an injection needle was 0 (range 0 – 1). Endoscopic vessel sealing was performed a mean of 3 times (range 0 – 7). The median number of bleeding episodes requiring treatment with hemostatic forceps was 0 (range 0 – 5). There were no significant adverse events. Seven of 52 patients (13.5 %) reported symptoms of gastroesophageal reflux disease such as heartburn or acid reflux at 3 month follow-up. Conclusions The FlushKnife BT enabled POEM to be performed with very few device exchanges, either for re-injection or to control intraoperative bleeding. In this uncontrolled case series, the ability of the FlushKnife BT to perform nearly all aspects of the POEM procedure seems to make it particularly well suited to this procedure.

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