Outcomes of per-oral endoscopic myotomy for treatment of esophageal achalasia with a median follow-up of 49 months

Abstract

POEM is a highly safe and effective treatment for esophageal achalasia with favorable long-term outcomes.

Feasibility of Using an Led-Probe in Third-Space Endoscopy: A Clinical Study

“…We didn't have technical problems during assembly or during procedures, neither when insertion into the patient was performed or after LP was used and procedures were finished. Therefore, based on these results, we confirmed the safety and efficacy of this device, that had a median insertion time of 5 minutes (4-6) for POEM and 6 (5-7) for G-POEM, without compromising total procedural times, and being similar to those observed in previous studies [5][6][7]10,11,21,24]. POEM was performed as described by other groups [5,6,21], with similar demographic characteristics.…”

“…They found no differences in clinical outcomes between groups (83% vs 80%; P=1.0), without differences in reflux disease incidence, but more cases with grade B esophagitis were presented in treatment group (25% vs 4%; P=0.049); they hypothesize that this is because a longer myotomy is performed in them (1.6±1.2cms) [26]. In our cases, the LP allowed performing an adequate EGJ myotomy and, at 6month evaluation, clinical outcomes and the occurrence of reflux disease was similar to those of other studies [5][6][7][8]12,13,21]. This suggests that the adequate confirmation of EGJ myotomy is the most important step in POEM procedures, regardless of whether an external device is used or not.…”

“…Third-space endoscopy has emerged as a novel and effective method for the treatment of different gastrointestinal disorders such as achalasia and refractory gastroparesis [1][2][3][4]. However, difficult or incomplete myotomy has been identified in peroral endoscopy myotomy (POEM) and gastric-peroral endoscopy myotomy (G-POEM) as a result of different factors such as end-stage disease or previously treated cases (due to high submucosal fibrosis) [1,5], inability to identify the esophagogastric junction (EGJ) throughout the submucosal tunnel during POEM [6][7][8] or the pyloric muscle ring (PMR) during G-POEM [9], lack of third-space endoscopy experience [2,3,6], and certain anatomical factors (megaesophagus, sigmoid-type) [4,9,10]. These factors are associated with a failed procedure.…”

“…Among them, achalasia and gastroparesis are the most prevalent diseases treated by this technique. However, "difficult", "incomplete", or even "not possible" tunnel creation or myotomy have been described and are associated with certain complexity factors such as end-stage disease (POEM)[5], previouslytreated cases (POEM and G-POEM)[4,8,24], inability to identify EGJ (POEM)[6][7][8], PMR (G-POEM)[9], high submucosal fibrosis (POEM and G-POEM)[2][3][4][6][7][8], lack of experience (POEM and G-POEM)[2,3,6],or anatomical factors (POEM)[1,4,9,10]…”

“An Odyssey of Third Space Endoscopy”—from Entry into the Tunnel to Entry into the Peritoneal Cavity

“…After a decade of its introduction, now we have enough data to suggest POEM as the modality of choice as it is incisionless, it tackles the whole LES and also the esophageal body in patients with type-III achalasia, requires short-hospital stay and has durable long-term efficacy of >85%. 11,12 A recent randomized trial in treatment naïve patients has shown the efficacy of POEM to be >90% at 2 years when compared with 54% for PD. 13 Moreover, patients with failed LHM and PD and those with end-stage burnt out disease (sigmoid esophagus) also show a good technical and clinical success with POEM [14][15][16] (►Table 1).…”