Long-term clinical results of per-oral endoscopic myotomy (POEM) for achalasia: First report of more than 10-year patient experience as assessed with a questionnaire-based survey

Onimaru, Manabu; Inoue, Haruhiro; Fujiyoshi, Yusuke; Abad, Mary Raina Angeli; Nishikawa, Yohei; Toshimori, Akiko; Shimamura, Yuto; Tanabe, Minoru; Sumi, Kazuya; Ikeda, Haruo

doi:10.1055/a-1333-1883

Cited by 26 publications

(35 citation statements)

References 31 publications

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“…Our results suggest that in pediatric achalasia, the response to POEM is sustained for at least 4 years. The results are similar to those in adult patients in whom clinical success has been recorded in 80-95% of cases at a median follow-up ranging from 3 to 7 years (16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”

Section: Discussionsupporting

confidence: 85%

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

et al. 2022

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Background and AimPer-oral endoscopic myotomy (POEM) is emerging as an effective treatment for pediatric achalasia. There are limited data on the long-term efficacy of POEM in children and adolescents with achalasia. In this study, we aim to evaluate the outcomes of POEM at ≥4 years follow-up.MethodThe data of consecutive children who underwent POEM (September 2013–July 2021) and completed at least 4 years follow-up were analyzed retrospectively. The primary outcome was clinical success (Eckardt ≤ 3) at ≥4 years follow-up. The secondary outcomes included the prevalence of gastroesophageal reflux disease (GERD) and predictors of recurrent symptoms (Eckardt ≥2) after POEM.ResultsA total of 69 children underwent POEM for achalasia during the study period. Of these, 41 (59.4%) children completed ≥4 years [mean 68.5 months (range 48–94)] follow-up, and 38 were included in the final analysis. The subtypes of achalasia included type I (28.9%), type II (60.5%), and type III (2.6%). There was a history of prior treatment in 11 children (28.9%). Clinical success was recorded in 36 (94.7%) patients who successfully underwent POEM. Recurrent symptoms (Eckardt ≥ 2) were noticed in 12 (31.6%) children at ≥4 years. On multivariate analysis, there were no identifiable factors which predicted recurrent symptoms after POEM. Symptomatic GERD and erosive esophagitis were detected in 13.8% (4/29) and 57.1% (8/14) of the children, respectively.ConclusionPOEM is a durable treatment modality for achalasia in the pediatric population irrespective of the sub-type of achalasia and history of prior treatment.

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Section: Discussionsupporting

confidence: 85%

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

et al. 2022

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“…The overall procedural time was comparable to that of the average time in our institution. 10 Improvement in the ESS as well as the barium esophagogram and HRM findings on 2‐month follow‐up exhibited that although POEM was performed in a reversed orientation, similar effects and outcomes were achieved, indicating a successful procedure in this case.…”

Section: Discussionmentioning

confidence: 59%

“…The overall procedural time was comparable to that of the average time in our institution. 10 Improvement in the ESS as well as the barium esophagogram and HRM findings…”

Section: Discussionmentioning

confidence: 99%

“…An inadequate or incomplete myotomy on the gastric side is the main risk factor for clinical failure of POEM. Confirmation of the myotomy length must be performed with the double scope method along with identification of the palisade vessels in the esophageal side and submucosal spindle veins in the gastric side 9,10 . During the double‐scope method, one endoscope is inserted into the submucosal tunnel then subsequently observing its transillumination with the second endoscope in retroflexed view of the gastric cardia.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of achalasia with peroral endoscopic myotomy in situs inversus totalis

et al. 2021

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Peroral endoscopic myotomy (POEM) has become established as a safe, effective, and versatile minimally invasive endoscopic treatment for achalasia and other esophageal motility disorders. Situs inversus totalis is a rare congenital disorder characterized by a completely reversed position (mirror‐image) of the thoracic and abdominal visceral organs. This case report demonstrated a successful treatment of achalasia in a situs inversus totalis by POEM. Similar to the POEM procedure in a normal patient, it is important to maintain the orientation throughout the submucosal tunneling while keeping in mind the reversed orientation and anatomical landmarks. The submucosal tunnel and myotomy were created by an anterior approach which is in this case located at the reversed axis, at 10 o'clock position. There were no major technical modifications needed to be carried out by the operator. No adverse events were noted. Improvement in the Eckardt Symptom Score as well as the barium esophagogram and high‐resolution manometry findings on 2‐month follow‐up exhibited that although POEM was performed in a reversed orientation, similar effects and outcomes were achieved, indicating a successful procedure in this case. In summary, by keeping in mind the reversed positioning and anatomical landmarks in situs inversus totalis, POEM shows to be a safe, effective, and versatile intervention in treating achalasia in situs inversus totalis without the need for major modifications in the procedural technique.

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“…More recent studies suggest that the response to POEM may be durable as well. [1][2][3][4][5][6][7][8][9] Campagna et al evaluated the outcomes of POEM in 100 patients who completed ≥4 years of follow-up. 6 Clinical success was recorded in 88% and objective evidence of gastroesophageal reflux disease (GERD) found in one-third of cases on long-term follow-up.…”

Section: Long-term Outcomes Of Per-oral Endoscopic Myotomymentioning

confidence: 99%

Third-Space Endoscopy: Recent Updates

Nabi

Reddy

2021

Journal of Digestive Endoscopy

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Third space or submucosal space is a potential space which on expansion allows the endoscopist to execute a multitude of therapeutic procedures for various gastrointestinal diseases like achalasia, subepithelial tumors, Zenker’s diverticulum, and refractory gastroparesis. Third space was first utilized for performing endoscopic myotomy in cases with achalasia cardia about a decade ago. Since then, the field of submucosal endoscopy has witnessed an exponential growth. The present review focuses on recent advances in the field of third-space endoscopy. With regard to per-oral endoscopic myotomy (POEM) in achalasia cardia, several recent studies have evaluated the long-term outcomes of POEM, compared endoscopic myotomy with pneumatic dilatation (PD) and surgical myotomy, and evaluated the outcomes of short- versus long-esophageal myotomy. In addition, the utility of multiple dose antibiotic prophylaxis to prevent infections after POEM has been questioned. Overall, the results from these studies indicate that POEM is a durable treatment modality, equally effective to Heller’s myotomy and superior to PD. With regard to gastric-POEM (G-POEM), recent studies suggest only modest efficacy in cases with refractory gastroparesis. Therefore, quality studies are required to identify predictors of response to optimize the outcomes of G-POEM in these cases. Another third-space endoscopy procedure that has gained popularity is endoscopic division of septum in cases with esophageal diverticula including Zenker’s POEM and epiphrenic diverticula POEM (Z-POEM and D-POEM, respectively). The technique of diverticulotomy using the principles of submucosal endoscopy appears safe and effective in short term. Data on term outcomes are awaited and comparative trials with flexible endoscopic myotomy required. Per-rectal endoscopic myotomy (PREM) is the most recent addition to third space endoscopy procedures for the management of short-segment Hirschsprung’s disease. Limited data suggest that PREM may be a promising alternative surgery in these cases. However, quality studies with long-term follow-up are required to validate the outcomes of PREM.

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Long-term clinical results of per-oral endoscopic myotomy (POEM) for achalasia: First report of more than 10-year patient experience as assessed with a questionnaire-based survey

Cited by 26 publications

References 31 publications

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

Treatment of achalasia with peroral endoscopic myotomy in situs inversus totalis

Third-Space Endoscopy: Recent Updates

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