Per-oral endoscopic myotomy, 1000 cases later: pearls, pitfalls, and practical considerations

Bechara, Robert; Onimaru, Manabu; Ikeda, Haru; Inoue, Haruhiro

doi:10.1016/j.gie.2016.03.1469

Cited by 99 publications

(64 citation statements)

References 13 publications

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“…The risk factors for major adverse events were short experience with the technique (<1 year), air insufflation, and mucosal edema. The results of this study are consistent with those reported in the literature [3,4,31]; also, this study confirmed that the use of CO 2 dramatically decreases the risk of complications.…”

Section: Overall Major Adverse Eventssupporting

confidence: 92%

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Complications of submucosal endoscopy

Gonzalez

Benezech

Barthet

2016

Best Practice & Research Clinical Gastroenterology

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Section: Overall Major Adverse Eventssupporting

confidence: 92%

“…For the mucosal closure it is important to follow several advices that have been described by Bechara et al in their recent experience of 1,000 patients [31]. It is crucial to emphasize the importance of symmetrical clip deployment.…”

Section: During the Proceduresmentioning

confidence: 99%

Complications of submucosal endoscopy

Gonzalez

Benezech

Barthet

2016

Best Practice & Research Clinical Gastroenterology

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“…An endoscopic submucosal injection of dyed saline is followed by a mucosal incision, and subsequent creation of a submucosal tunnel to expose the circular muscle fibers at a length 2-3 cm beyond the LES. Selective circular muscle myotomy is then carried out under direct visualization, and the mucosa is closed with clips [47]. Advancements in technology as well as refinements in technique have led to safer procedures, as well as decreased operative time.…”

Section: Treatmentmentioning

confidence: 99%

“…POEM has even been performed successfully on refractory cases of achalasia following previous balloon dilation or laparoscopic Heller myotomy [52][53][54][55]. These cases should only be treated by highly experienced operators [47]. The advantage of POEM over surgical myotomy is that the length of the myotomy from the esophageal to gastric side can be adjusted freely to suit the individual case.…”

Section: Treatmentmentioning

confidence: 99%

Current status of achalasia management: a review on diagnosis and treatment

Tuason

Inoue

2017

J Gastroenterol

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Background Achalasia is a rare esophageal motility disorder that is characterized by loss of peristalsis and failure of relaxation of the lower esophageal sphincter (LES), particularly during swallowing. This review focuses on the diagnosis of esophageal motility disorders as defined by the Chicago Classification ver 3.0, and presents management options with regard to per-oral endoscopic myotomy (POEM) as the treatment of choice. Methods A concise review of literature was performed for articles related to the management of achalasia, and this was contrasted with our institution's current practice. Results Achalasia is still incompletely understood, and management is focused on establishing a proper diagnosis, and relieving the obstructive symptoms. Conclusions Achalasia should be considered when dysphagia is present, and not otherwise caused by an obstruction or inflammation, and when criteria is met as per the Chicago Classification ver 3.0. Lowering LES tone and disruption of LES can be accomplished by various methods, most notably pneumatic balloon dilatation and surgical myotomy. POEM has been gaining momentum as a first line therapy for achalasia symptoms, and can be considered an important tool for motility disorders of the esophagus.

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“…Indeed, the pioneering Japanese center for refining the technique recently summarized technical pearls and pitfalls on performing POEM gleaned from their first 1000 procedures. 2 Uncontrolled outcomes data have been very promising comparing POEM with the standard surgical treatment for achalasia, laparoscopic Heller myotomy (LHM). 3 However, concerns remain regarding post-POEM reflux, the durability of the procedure, and the learning curve for endoscopists adopting the technique.…”

mentioning

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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Per-oral endoscopic myotomy, 1000 cases later: pearls, pitfalls, and practical considerations

Abstract: The dissemination of this information serves as a foundation for new POEM operators and as a catalyst for more-experienced operators to further refine and advance their POEM skills and stimulate international discourse and collaboration.

Cited by 99 publications

References 13 publications

Complications of submucosal endoscopy

Complications of submucosal endoscopy

Current status of achalasia management: a review on diagnosis and treatment

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

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