Outcomes and quality of life assessment after per oral endoscopic myotomy (POEM) performed in the endoscopy unit with trainees

Dacha, Sunil; Wang, Lei; Li, Xaioyu; Jiang, Yueping; Philips, George; Keilin, Steven; Willingham, Field F.; Cai, Qiang

doi:10.1007/s00464-017-6015-x

Cited by 14 publications

(16 citation statements)

References 29 publications

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“…17 All 6 trainees could perform POEM independently in the presence of the mentor, confirming our observation in previous studies. 17 The main strengths of our study were the relatively large sample size as well as the long-term follow-up as compared with the first report of POEM in the United States and the first report of the long-term outcome of POEM performed with trainees. Nevertheless, our study has several limitations.…”

Section: Discussionsupporting

confidence: 89%

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Long-term Outcome of Per-oral Endoscopic Myotomy Performed in the Endoscopy Unit With Trainees

Abdelfatah¹,

Calderon²,

Koldhekar³

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Introduction: Per-oral endoscopic myotomy (POEM) has been widely adopted for the treatment of achalasia as it provides a precise, tailored myotomy in a minimally invasive endoscopic procedure. Several shortterm studies and a few long-term studies have confirmed that POEM is a safe and effective treatment for achalasia. However, the long-term outcome of POEM performed by trainees is unknown. Materials and Methods:We conducted a retrospective study of all patients who underwent POEM for achalasia at our tertiary care center during December 2012 and January 2019. All procedures performed with trainees were included. The primary outcome was the clinical response to POEM, defined as an Eckardt score of <3 after POEM. Trainees were trained in performing mucosotomy and submucosal dissection, creating a submucosal tunnel, identifying gastroesophageal junction, and performing myotomy and closure of mucosal incision in a step-by-step fashion. Trainees' performance was evaluated by the mentor based on several key points in each step.Results: A total of 153 consecutive patients with a median age of 57 ± 18 years were analyzed in this study. Of the total patients, 69 (45%) were male. The median length of follow-up after POEM was 32 months (range: 7 to 77 mo). A clinically significant response to POEM was achieved in 95% of patients at year 1, 84% at year 2, 80% at year 3, 79% at year 4, 78% at year 5, and 78% at year 6 and above. All trainees obtained competence within 6 cases for each step and could perform the procedure alone after 20 supervised cases.Conclusions: Overall, 78% of patients maintained positive clinical response at 6 years following POEM procedure. The recurrence rate of symptoms following POEM was 22% at a 6-year follow-up. This long-term outcome of POEM performed with trainees was comparable to those without trainees in other studies. To our knowledge, this is the longest follow-up and the largest number of patients after the POEM procedure performed with trainees.

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Section: Discussionsupporting

confidence: 89%

“…Trainees' protocol was published on our prior study. 17 Briefly, as show in Table 1, each trainee started with dissecting and establishing a submucosal tunnel. They then performed the myotomy inside the tunnel and created a submucosal tunnel orifice.…”

Section: Trainees During the Proceduresmentioning

confidence: 99%

Long-term Outcome of Per-oral Endoscopic Myotomy Performed in the Endoscopy Unit With Trainees

Abdelfatah¹,

Calderon²,

Koldhekar³

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…The POEM procedure was performed as has been described previously. 18 First, a submucosal injection of a solution of 1 mL methylene blue and 1 mL epinephrine mixed with 500 mL of 0.9% normal saline was used to lift the mucosa at the site of the initial mucosotomy. The initial mucosal incision was made longitudinally starting at approximately 10 cm above the squamocolumnar junction using an I-Type Hybrid Knife (ERBE, Marietta, GA, USA).…”

Section: Methodsmentioning

confidence: 99%

Gas Leak and Mucosal Injury During Endoscopic Esophageal Myotomy After Previous Myotomy: A Single-Center Experience

Samo¹,

Hamo²,

Jain³

et al. 2021

CEG

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Purpose: Peroral endoscopic myotomy (POEM) after prior myotomy (PM-POEM) can be technically challenging with possible increased adverse events. We aimed to assess gas leak and mucosal injury incidence during PM-POEM, compared to an index POEM (iPOEM), and post-procedure extubation time. Patients and Methods: A retrospective study comparing PM-POEM to iPOEM from March 2016 to August 2018. Results: There were 21 subjects in the PM-POEM and 56 subjects in the iPOEM. The PM-POEM group was younger (average age 44.33 vs 57.57 years, p=0.0082). Gas leak incidence did not differ between groups (28.6% in PM-POEM vs 14.3% in iPOEM, p=0.148). For cases with imaging available postoperatively, there was a trend towards higher incidence of gas leak in the PM-POEM, but it was not statistically significant (60% vs 42.1%, p=0.359). The post-procedure extubation time was not different between PM-POEM and iPOEM (11.38 vs 9.46 minutes, p=0.93), but it was longer when gas leak occurred (15.92 vs 8.67 minutes, p=0.027). The odds of mucosal injury were four-fold higher (OR, 4.31; 95% CI, 1.32-14.08), and more clips were used to close mucosal injuries (0.62 vs 0.14 clips, p=0.0053) in the PM-POEM group. More procedures were deemed difficult or challenging in the PM-POEM (33.3% vs 7.1%, p=0.007). The number of clips used to close the mucosotomy was not different between groups (4.05 vs 3.84 clips, p=0.498). Although the myotomy was shorter in PM-POEM, it was not statistically significant (6.38 vs 7.14 cm, p=0.074). However, the procedure was longer in PM-POEM (61.28 vs 45.39 minutes, p=0.0017). There was no intervention or ICU admission required pertinent to the procedure. Conclusion:Performing PM-POEM can be more difficult with more mucosal injuries. Gas leak was associated with a slightly longer post-procedure extubation time, but clinical relevance is unclear given incidence of gas leak was unknown at time of extubation.

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“…These critical steps include submucosal entry, preemptive coagulation of submucosal vessels and perforating arteries, and mucosotomy closure. [14][15][16] Subsequently, after gaining more experience, trainees should be able to independently perform all the steps of the POEM procedure as described below.…”

Section: Poem Hands-on Trainingmentioning

confidence: 99%

Core curriculum for peroral endoscopic myotomy (POEM)

Dacha

Aihara

Anand

et al. 2021

Gastrointestinal Endoscopy

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Outcomes and quality of life assessment after per oral endoscopic myotomy (POEM) performed in the endoscopy unit with trainees

Cited by 14 publications

References 29 publications

Long-term Outcome of Per-oral Endoscopic Myotomy Performed in the Endoscopy Unit With Trainees

Long-term Outcome of Per-oral Endoscopic Myotomy Performed in the Endoscopy Unit With Trainees

Gas Leak and Mucosal Injury During Endoscopic Esophageal Myotomy After Previous Myotomy: A Single-Center Experience

Core curriculum for peroral endoscopic myotomy (POEM)

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