Impact of peroral endoscopic myotomy on high-resolution manometry findings and their association with the procedure’s outcomes

Hata, Yoshitaka; Sato, Hiroki; Shimamura, Yuto; Abe, Hirofumi; Shiwaku, Akio; Shiota, Junya; Sato, Chiaki; Ominami, Masaki; Fukuda, Hisashi; Ogawa, Ryo; Nakamura, Jun; Tatsuta, Tetsuya; Ikebuchi, Yuichiro; Yokomichi, Hiroshi; Ihara, Eikichi; Inoue, Haruhiro

doi:10.1016/j.gie.2022.10.039

Cited by 5 publications

(3 citation statements)

References 42 publications

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“…We respect that each of these disorders has a different pathophysiology, and, ideally, these distinct disorders should have been analyzed separately. Lastly, post-POEM manometry was not done as the data regarding its utility in this scenario are scarce and do not seem to contribute to the clinical outcome or patient quality of life 25 …”

Section: Discussionmentioning

confidence: 99%

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Short-term Outcome of Peroral Endoscopic Myotomy Performed by the Same Endoscopist on Achalasia and Nonachalasia Esophageal Motility Disorders

Mubashir,

Andrus,

Okuampa

et al. 2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Peroral endoscopic myotomy (POEM) is a relatively new but increasingly therapeutic option for achalasia. In recent years, POEM has been used for nonachalasia esophageal motility disorders (NAEMDs), such as diffuse esophageal spasm, esophagogastric junction outlet obstruction, and hypercontractile disorder, with some clinical success. No studies thus far compare the outcomes of these two groups. We perform the first head-to-head comparison of outcomes after POEM in patients with achalasia and NAEMD. Patients and Methods: A retrospective analysis of all patients undergoing POEM at one university hospital by a single expert endoscopist from July 2021 to December 2022 was performed. All patients were symptomatic, and the presence of esophageal motility disorders was confirmed using multiple diagnostic modalities. These patients were then divided into 2 groups, achalasia and NAEMD, based on the underlying diagnosis. Statistical analysis of different clinical outcomes, including effectiveness and safety, was performed. Results: Thirty-seven patients (mean age: 59.55, females: 22) underwent POEM in the study period. Twenty patients had achalasia and 17 patients had NAEMD. The median myotomy length was 5.5 cm for the achalasia group and 10 cm for the NAEMD group. This excluded patients with esophagogastric junction outlet obstruction in which the median myotomy length was 3 cm. The procedure time, the duration of hospital stays, the rates of same-day discharge, and complications were similar between the two. Short-term outcomes of POEM for the two groups were similar with improvement in 94% of patients in the achalasia group and 93.75% in the NAEMD group. Conclusion: Contrary to prior observations, our study highlights that POEM is equally effective in achieving clinical improvement in patients with NAEMD as achalasia over 6 months of follow-up. In addition, POEM has a comparable safety profile in both patient groups making it a feasible therapeutic option for these debilitating and challenging disorders.

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Section: Discussionmentioning

confidence: 99%

“…Lastly, post-POEM manometry was not done as the data regarding its utility in this scenario are scarce and do not seem to contribute to the clinical outcome or patient quality of life. 25…”

Section: Discussionmentioning

confidence: 99%

Short-term Outcome of Peroral Endoscopic Myotomy Performed by the Same Endoscopist on Achalasia and Nonachalasia Esophageal Motility Disorders

Mubashir,

Andrus,

Okuampa

et al. 2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

show abstract

“…Even though the median of post-POEM IRP was higher than 15 mmHg (17.2 mmHg) but Eckardt score was lower than 3 can be explained by a multicenter, observational cohort study reported by Hata Y et al 21 studied the associations between post-POEM HREM and the outcomes of POEM. 7% (151 of 2,171 patients) showed residual high post-POEM IRP (≥ 26 mmHg; Starlet [Starmedical Ltd, Tokyo, Japan]) still have comparable clinical outcome with low post-POEM IRP patients.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Per-Oral Endoscopic Myotomy in the Treatment of Esophageal Achalasia: Over One Hundred Cases in a Single Tertiary Center

Laohavichitra,

Wannaprasert,

Raranachu-ek

2023

Siriraj Med J

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Objective: To study the outcomes and complications of per-oral endoscopic myotomy (POEM) in patients with esophageal achalasia. Materials and Methods: This retrospective observational study reviewed the medical records of esophageal achalasia patients who underwent POEM between March 2013 and September 2022. One hundred and eight cases were included. Results: A total of 108 consecutive patients were included in this study and classified into 4 groups: 30 (27.8%) as type I; 53 (49.1%) as type II; 5 (4.6%) as type III; and 20 (18.5%) as unspecified due to unsuccessful catheter placement across the esophagogastric junction. The mean patient age was 46.10+16.59, 77 (71.3%) patients were female. Ten (9.3%) of the patients had undergone prior treatment, including balloon dilation, POEM, Heller myotomy, and nitroglycerine. Technical success was achieved in 106 (98.1%) cases, clinical success was evaluated only in 88 patients who follow up more than 6 month and the median follow-up time was 20.50 months (range 6-110 months). The clinical success was accomplished in 82 (93.2%), and 26 (24.1%) patients experienced perioperative complications which were significantly associated with anterior myotomy and probably operator learning curve. One patient (1.1%) had recurrent symptoms at 24-month follow up. Gastroesophageal reflux disease (GERD) was found in 19 (21.6%) patients, all of whom responded well to proton pump inhibitors (PPIs). Conclusion: POEM is effective and safe in long-term treatment of achalasia. Although the incidence of symptomatic GERD was slightly high, the cases were not severe and were well controlled with medication.

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Preoperative manometric data can predict symptom improvement after per oral endoscopic myotomy for treatment of achalasia

et al. 2023

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Impact of peroral endoscopic myotomy on high-resolution manometry findings and their association with the procedure’s outcomes

Cited by 5 publications

References 42 publications

Short-term Outcome of Peroral Endoscopic Myotomy Performed by the Same Endoscopist on Achalasia and Nonachalasia Esophageal Motility Disorders

Short-term Outcome of Peroral Endoscopic Myotomy Performed by the Same Endoscopist on Achalasia and Nonachalasia Esophageal Motility Disorders

Outcomes of Per-Oral Endoscopic Myotomy in the Treatment of Esophageal Achalasia: Over One Hundred Cases in a Single Tertiary Center

Preoperative manometric data can predict symptom improvement after per oral endoscopic myotomy for treatment of achalasia

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