Per-oral endoscopic myotomy white paper summary

Stavropoulos, Stavros N.; Desilets, David J.; Fuchs, Karl Hermann; Gostout, Christopher J.; Haber, Gregory B.; Inoue, Haruhiro; Kochman, Michael L.; Modayil, Rani J.; Savides, Thomas J.; Scott, Daniel J.; Swanstrom, Lee L.; Vassiliou, Melina C.

doi:10.1016/j.gie.2014.04.014

Cited by 158 publications

(89 citation statements)

References 59 publications

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“…Post-procedure complications still arise, as with the other treatment modalities. On objective testing, the rate of gastroesophageal reflux disease (GERD) after POEM is 20-46%, which may not be significantly different from that observed after LHM with Dor fundoplication [62,63].…”

Section: Treatmentmentioning

confidence: 92%

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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Section: Treatmentmentioning

confidence: 92%

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

Tuason

Inoue

2017

J Gastroenterol

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“…Except for patients with secondary achalasia, all symptomatic achalasia patients can be treated with POEM. It is a useful technique not only for patients with achalasia but also for those other motility disorders, such as diffuse esophageal spasm, hypertensive LES, and nutcracker esophagus, and for those with failed conventional and surgical treatments, such as pneumatic dilation, botox injection, and Heller myotomy (6,9). In our case series, endoscopic and manometric studies were performed before POEM in all patients with achalasia; secondary achalasia and other causes of dysphagia, such as tumor, were excluded.…”

Section: Discussionmentioning

confidence: 99%

“…Side effects related to CO 2 insufflation are generally very well tolerated and occur as a result of CO 2 penetration through the muscular layer to the esophagus, mediastinum, neck, and peritoneum during the procedures, (6,12,15). Capnoperitoneum occurs frequently (>50%) and is usually clinically insignificant; however, when respiratory problems occur or when the abdomen is excessively distended, treatment of this complication can easily be achieved by inserting a desufflation needle (Veress needle) into the peritoneum (6,18,19). In our case series, desufflation of excess air in the abdomen by needle was required in 2 patients.…”

Section: Original Articlementioning

confidence: 99%

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The last innovation in achalasia treatment; per-oral endoscopic myotomy

Aslan

Akpınar²,

Alper³

et al. 2015

Turk J Gastroenterol

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Background/Aims: Per-oral endoscopic myotomy (POEM) is a minimally invasive endoscopic treatment option for patients with achalasia and has been performed since 2010. It is less invasive than Heller myotomy and its use is spreading rapidly worldwide. We present our results of POEM that, to the best of our knowledge, are the first cases in Turkey. Materials and Methods: We enrolled patients between May 2014 and September 2014; 8 patients with achalasia whose complaints recurred after pneumatic balloon dilatation underwent POEM. The procedure was performed under general anesthesia at the endoscopy unit of the gastroenterology clinic. Demographic data was recorded before the procedure, and the results of the procedure were recorded prospectively. Results: The median age of the patients was 42.5 (30-72) years. Preoperative and postoperative median Eckardt scores were 10 (8-12) and 1 (0-2), respectively. The median total duration of the procedure was 101 (71-158) min, and the median myotomy length was 13.5 (10-16) cm. Postoperative oral intake started on median day 1 (1-2) and the length of hospital stay was 4 (3-6) days. In 2 patients, capnoperitoneum developed during the procedure and was treated with a Veress needle. Conclusion: POEM is a safe endoscopic treatment modality for patients with achalasia in centers that are experienced in advanced endoscopic techniques.

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“…Intravenous proton pump inhibitors are typically given preoperatively due to the high incidence of postoperative reflux (19). Intravenous antibiotic prophylaxis should be administered for a standard non-cardiac thoracic procedure and may include cefazolin or clindamycin (16)(17)(18)(19)(20).…”

Section: Pre-and Intraoperative Considerationsmentioning

confidence: 99%

The current state of per oral endoscopic myotomy for achalasia

Smith

Louie

2017

J. Vis. Surg.

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Achalasia is an acquired neuromuscular disorder that has been treated using a variety of modalities throughout medical history. Recently, the technique of per oral endoscopic myotomy (POEM) was introduced to treat the disease using a truly minimally invasive, natural orifice technique that is rapidly being adopted across the world. This review outlines the development of POEM, the technique itself, and gives a comparison to other procedures, specifically laparoscopic Heller myotomy (LHM).

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Per-oral endoscopic myotomy white paper summary

Cited by 158 publications

References 59 publications

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

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

The last innovation in achalasia treatment; per-oral endoscopic myotomy

The current state of per oral endoscopic myotomy for achalasia

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