Clinical practice guidelines for peroral endoscopic myotomy

Abstract

Peroral endoscopic myotomy (POEM) is a novel clinical technique developed in Japan used to treat esophageal achalasia and esophageal motility disorders. This technique has been rapidly accepted and widely disseminated throughout our clinical practice because of its low invasiveness, technical novelty, and high efficacy. Since the advent of POEM, there have been no clinical guidelines that clearly indicated its standard of care, and these guidelines have been anticipated both nationally and internationally by clinicians who engage in POEM practice. In 2017, to meet these needs, the Japan Gastroenterological Endoscopy Society (JGES) launched the guideline committee for POEM. Based on the guideline development process proposed by the Medical Information Network Distribution Service (MINDS), the guideline committee initially created research questions on POEM and conducted a systematic review and meta-analysis on each topic. The clinical research extracted from databases for these clinical questions and the systematic review mainly comprised a few retrospective studies with a small number of participants and short trial periods; hence, the strength of the evidence and recommendations derived from these results was low. Throughout this process, the guideline committee met thrice: once on May 13, 2017, and again on September 17, 2017, to formulate the draft. A consensus meeting was then held on January 14, 2018, in Tokyo to establish the guideline statements and finalize the recommendations using the modified Delphi method. This manuscript presents clinical guidelines regarding current standards of practice and recommendations in terms of the nine chief topics in POEM.

Clinical outcomes of per‐oral endoscopic tumor resection for submucosal tumors in the esophagus and gastric cardia

“…The technique of POET is based on the tunneling concept developed for POEM, in which the endoscopic resection occurs in the submucosal space while maintaining the integrity of the overlying mucosa. POEM is now performed worldwide and has been shown to be safe and effective without any severe adverse events or postoperative strictures . Our study also demonstrates that the technique of POET, like POEM, is also safe and effective.…”

Usefulness of a newly developed distal attachment: Super soft hood (Space adjuster) in therapeutic endoscopy

“…Advanced techniques are required to carry out therapeutic endoscopy including endoscopic submucosal dissection (ESD), peroral endoscopic myotomy (POEM), and peroral endoscopic tumor resection (POET) . In order to achieve efficient procedures, a newly developed transparent distal attachment: super soft hood (Space adjuster; TOP, Tokyo, Japan) was designed (Fig.…”

Japanese guidelines for peroral endoscopic myotomy: 1st edition

“…Just a decade ago, peroral endoscopic myotomy (POEM) was carried out for the first time to treat esophageal achalasia by Inoue et al . most of whom are committee members for the development of clinical practice guidelines for POEM . Three guidelines have been published for esophageal achalasia, including the Esophageal Achalasia Guidelines (I‐GOAL) proposed and endorsed by the International Society for Diseases of the Esophagus (ISDE) .…”

“…Three guidelines have been published for esophageal achalasia, including the Esophageal Achalasia Guidelines (I‐GOAL) proposed and endorsed by the International Society for Diseases of the Esophagus (ISDE) . The current Japanese achalasia guidelines are specific to POEM, and offer endoscopists and surgeons a useful and up‐to‐date resource for applying the best principles of this innovative and potentially disruptive endoscopic technique to manage achalasia. Statements or comments on the clinical role of POEM for pediatric and idiopathic achalasia and detailed POEM management of other esophageal motor disorders will be added to the next versions of the Japanese POEM guidelines.…”

“…Then, the committee created 22 clinical questions (CQ) relevant to the safe performance and introduction of POEM procedures in equipped institutes. Based on the guideline development process proposed by the Medical Information Network Distribution Service, the guideline committee initially created research questions on POEM and conducted a systematic review and meta‐analysis on each topic, given the rarity of this disease, and the paucity of high‐level evidence in the literature without long‐term outcome data …”