Comprehensive Analysis of Adverse Events Associated With Per Oral Endoscopic Myotomy in 1826 Patients: An International Multicenter Study

Haito-Chavez, Yamile; Inoue, Haruhiro; Beard, Kristin W.; Draganov, Peter V.; Ujiki, Michael; Rahden, Burkhard H. A. von; Desai, Pankaj; Pioche, Mathieu; Hayee, Bu; Haji, Amyn; Saxena, Payal; Reavis, Kevin M.; Onimaru, Manabu; Balassone, Valerio; Nakamura, Jun; Hata, Yoshitaka; Yang, Dennis; Pannu, Davinderbir; Abbas, Ali; Perbtani, Yaseen B.; Patel, Lava; Filser, Jörg; Roman, Sabine; Rivory, Jérôme; Mion, François; Ponchon, Thierry; Perretta, Silvana; Wong, Vivien W.; Maselli, Roberta; Ngamruengphong, Saowanee; Chen, Yen I.; Bukhari, Majidah; Hajiyeva, Gulara; Ismail, Amr; Pieratti, Renata; Kumbhari, Vivek; Galdos-Cardenas, Gerson; Repici, Alessandro; Khashab, Mouen A.

doi:10.1038/ajg.2017.139

Cited by 166 publications

(131 citation statements)

References 26 publications

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“…The PDS was shown to correlate well with procedural velocity and is an accurate measure of procedural difficulty. It has previously been shown that operative time indirectly correlates with complications . This supports the theory that the PDS will also correlate with complication rate.…”

Section: Discussionsupporting

confidence: 76%

Peroral endoscopic myotomy (POEM) for complex achalasia and the POEM difficulty score

Bechara

Woo

Hookey

et al. 2019

Digestive Endoscopy

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Background Peroral endoscopic myotomy (POEM) for achalasia is technically challenging to carry out in patients with type III, multiple prior treatments, prior myotomy, and sigmoid type. Herein, we present a series of consecutive patients with complex achalasia and introduce the POEM difficulty score (PDS). Aim To demonstrate the application and discuss the utility of PDS and present the feasibility, safety, and efficacy of POEM in complex achalasia patients. Methods Forty consecutive POEM were carried out with 28 meeting the criteria for complex achalasia. Primary outcome was clinical success (Eckardt score ≤3) at a minimum of 3 months follow‐up. Secondary outcomes included adverse events, procedural velocity and PDS. Results Twenty‐eight complex and 12 non‐complex POEM procedures were carried out with 100% and 92% clinical success, respectively, without any major adverse events with a median follow up of 15 months (complex) and 8 months (non‐complex). Mean velocities for non‐complex, type III, prior myotomy, ≥4 procedures and sigmoid type were as follows: 4.4 ± 1.6, 4.8 ± 1.5, 5.9 ± 2.2, 6.9 ± 2.2 and 8.2 ± 3.2 min/cm, respectively. Median PDS for non‐complex, type III, prior myotomy, ≥4 treatments and sigmoid type were 1 (0–3), 2 (0–4), 2.5 (1–6), 3 (2–6) and 3.5 (1–6), respectively. PDS was shown to correlate well with procedural velocity with a correlation coefficient of 0.772 (Spearman's P < 0.001). Conclusions PDS identifies the factors that contribute to challenging POEM procedures and correlates well with procedural velocity. The order of increasing difficulty of POEM in complex achalasia appears to be type III, prior myotomy, ≥4 treatments and sigmoid type.

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Section: Discussionsupporting

confidence: 76%

Peroral endoscopic myotomy (POEM) for complex achalasia and the POEM difficulty score

Bechara

Woo

Hookey

et al. 2019

Digestive Endoscopy

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“…A multicenter comprehensive analysis of 1826 patients reported mild, moderate, and severe adverse events occurring with frequencies of 6.4%, 1.7%, and 0.5%, respectively. 47 One of the greatest concerns after POEM is reflux, evidence of which is observed in up to 58% of patients (Table 2). 42 …”

Section: Per-oral Endoscopic Myotomy Vs Laparoscopic Heller Myotomy: mentioning

confidence: 99%

“…One report suggests a doubling of adverse events with POEM in patients with sigmoid esophagus. 59 Table 3 outlines distinguishing treatment considerations among the achalasia syndromes, along with preferred treatment options and rationale for each. Note that the suggestions made are based on expert opinion, given that no existing treatment trial has ever stratified patients to this degree.…”

Section: Phenotype-directed Treatment: Where Does Per-oral Endoscopicmentioning

confidence: 99%

Clinical Practice Update: The Use of Per-Oral Endoscopic Myotomy in Achalasia: Expert Review and Best Practice Advice From the AGA Institute

2017

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The purpose of this review is to describe a place for per-oral endoscopic myotomy (POEM) among the currently available robust treatments for achalasia. The recommendations outlined in this review are based on expert opinion and on relevant publications from PubMed and EMbase. The Clinical Practice Updates Committee of the American Gastroenterological Association proposes the following recommendations: 1) in determining the need for achalasia therapy, patient-specific parameters (Chicago Classification subtype, comorbidities, early vs late disease, primary or secondary causes) should be considered along with published efficacy data; 2) given the complexity of this procedure, POEM should be performed by experienced physicians in high-volume centers because an estimated 20–40 procedures are needed to achieve competence; 3) if the expertise is available, POEM should be considered as primary therapy for type III achalasia; 4) if the expertise is available, POEM should be considered as treatment option comparable with laparoscopic Heller myotomy for any of the achalasia syndromes; and 5) post-POEM patients should be considered high risk to develop reflux esophagitis and advised of the management considerations (potential indefinite proton pump inhibitor therapy and/or surveillance endoscopy) of this before undergoing the procedure.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Onimaru

Inoue

Bechara

et al. 2019

Digestive Endoscopy

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Objectives The clinical success of per‐oral endoscopic myotomy (POEM) has led to the development of a new field of ‘submucosal endoscopy’. This study aimed to evaluate the safety, efficacy, and limitations of per‐oral endoscopic tumor resection (POET) in the management of submucosal tumors (SMTs) in the esophagus and the gastric cardia. Methods POET was performed in 47 patients from January 2011 to December 2017. The indication for POET was SMTs ≤ 30 mm in minor axis diameter. Patient and tumor characteristics (age, gender, tumor location, size, and histology), operative and clinical results of POET (procedure time and completion rate, en bloc resection rate, length of hospitalization, adverse events and tumor recurrence) were analyzed retrospectively. Results POET was successfully completed in 43 patients (91.5%) without any major adverse events (Clavien‐Dindo IIIb‐IV). Four patients required conversion to an open surgical procedure due to suboptimal visualization during POET. Four patients underwent piecemeal resection of their SMTs including GISTs. Median follow‐up was 44 months (10–96 months), during that time, there were no incidences of tumor recurrence. Tumors that had a minor axis diameter > 30 mm or a tumor mass index (TMI) [major axis diameter (mm) × minor axis diameter (mm)] >1000 had a high likelihood of being converted to surgical resection. Conclusions POET is a safe and effective treatment for SMTs. However, in patients where the minor axis diameter is > 30 mm or the TMI > 1000, surgical excision should be considered. Furthermore, application of POET for SMTs with malignant potential should be carefully considered to ensure optimal oncologic outcomes.

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Comprehensive Analysis of Adverse Events Associated With Per Oral Endoscopic Myotomy in 1826 Patients: An International Multicenter Study

Cited by 166 publications

References 26 publications

Peroral endoscopic myotomy (POEM) for complex achalasia and the POEM difficulty score

Peroral endoscopic myotomy (POEM) for complex achalasia and the POEM difficulty score

Clinical Practice Update: The Use of Per-Oral Endoscopic Myotomy in Achalasia: Expert Review and Best Practice Advice From the AGA Institute

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

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