Peroral endoscopic myotomy alone is effective for esophageal motility disorders and esophageal epiphrenic diverticulum: a retrospective single-center study

Kinoshita, Masato; Tanaka, Shinwa; Kawara, Fumiaki; Sakaguchi, Hiroya; Abe, Hirofumi; Ariyoshi, Ryusuke; Toyonaga, Takashi; Kodama, Yuzo

doi:10.1007/s00464-019-07340-6

Cited by 26 publications

(28 citation statements)

References 21 publications

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“…Although the causal relationship between esophageal motility disorders and symptomatic ED is not clear, minimal invasive surgery involving diverticulectomy, myotomy, and elective fundoplication is routinely conducted. 4,5,10,11 The most recent meta-analysis 7 reported an in-hospital mortality rate of 5.9%, pooled morbidity rate of 21.1%, overall treatment success rate of 88.5%, and an overall staple line leakage rate of 13.3%. A diverticulectomy, in addition to surgery, is known to result in better treatment success and symptomatic resolution, while staple line leakage could be reduced by performing routine myotomy.…”

Section: Discussionmentioning

confidence: 99%

Parapneumonic Effusion and Tension Pneumothorax after Diverticular Peroral Endoscopic Myotomy in a Woman with Large Epiphrenic Diverticulum: A Case Report and Literature Review

Shiu

2021

Clin Endosc

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Esophageal diverticula (ED) represents a group of rare conditions that warrant intervention when they are symptomatic or coexisting with pulmonary disorders. Few literature reviews have described this patient entity or discussed the postoperative outcome. Therefore, I present the case of a 59-year-old woman with symptoms of dysphagia who was significantly underweight, which was conducive to the diagnosis of symptomatic ED. Because she was a poor candidate for surgery, she received a diverticular peroral endoscopic myotomy. She subsequently developed parapneumonic effusion and tension pneumothorax after the procedure. She was finally discharged on postoperative day 23. I also performed the first known comprehensive literature review of 34 published cases (including my patient) from PubMed and have addressed the demography, intervention, and prognosis for symptomatic ED after the procedure. Prompt treatment as well as prognostic measurement are crucial to successful outcomes.

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Section: Discussionmentioning

confidence: 99%

Parapneumonic Effusion and Tension Pneumothorax after Diverticular Peroral Endoscopic Myotomy in a Woman with Large Epiphrenic Diverticulum: A Case Report and Literature Review

Shiu

2021

Clin Endosc

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“…In a study published by Kinoshita et al, 14 patients with ED had significantly improved median Eckardt scores from 5 before POEM to 0 after POEM without septotomy (p< 0.0001). 26 The authors concluded that this should be the chosen first-line treatment for patients with ED and EMD, and septotomy (D-POEM) can be an additional option if POEM alone is unsuccessful. 26…”

Section: Outcomes Of Diverticular Peroral Endoscopic Myotomymentioning

confidence: 99%

“…26 The authors concluded that this should be the chosen first-line treatment for patients with ED and EMD, and septotomy (D-POEM) can be an additional option if POEM alone is unsuccessful. 26…”

Section: Outcomes Of Diverticular Peroral Endoscopic Myotomymentioning

confidence: 99%

Role of Peroral Endoscopic Myotomy (POEM) in the Management of Esophageal Diverticula

et al. 2020

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Esophageal diverticula are uncommon; however, when present, they can cause symptoms of dysphagia, regurgitation, and chest pain. Based on location and pathophysiological characteristics, they are classified as pulsion-and traction-type diverticula. In the past, the open surgical approach was the only treatment available; however, in the past few decades, transoral incisionless approaches in the form of rigid and flexible endoscopy have gained popularity. Diverticular peroral endoscopic myotomy has emerged as an alternative treatment option. In this paper, we reviewed the role of peroral endoscopic myotomy as a treatment option for different types of esophageal diverticula. Although a safe and effective procedure, this novel submucosal tunneling technique for the treatment of esophageal diverticula requires further validation, and head-to-head comparisons between the different approaches for the treatment of esophageal diverticula are warranted.

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“…If diverticulectomy is not necessary for symptomatic relief, endoscopic treatment for the motor disorder, such as forceful dilatation of the cardia, per oral endoscopic myotomy may be an attractive option. Initial results are promising, albeit mostly based on few case reports [17,[21][22][23] .…”

Section: Treatment Of the Dysmotility Without Diverticulectomymentioning

confidence: 99%

Minimizing complications after minimally invasive surgery for epiphrenic diverticula of the esophagus: technical tips

Herbella¹,

Patti²

2020

Mini-invasive Surg

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Epiphrenic diverticula occur within the distal 10 cm of the esophagus. Because they are secondary to an underlying esophageal motility disorder, the surgical treatment of these diverticula must include a myotomy in addition to the resection of the diverticulum. In selected cases, the diverticulum can be left in place, performing only the myotomy and the partial fundoplication. Most patients will eventually become asymptomatic and the diverticulum can be left in place. Overall, it is a challenging operation that may be associated to significant morbidity. In this review, we illustrate the key technical elements and how to troubleshoot eventual problems.

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Peroral endoscopic myotomy alone is effective for esophageal motility disorders and esophageal epiphrenic diverticulum: a retrospective single-center study

Cited by 26 publications

References 21 publications

Parapneumonic Effusion and Tension Pneumothorax after Diverticular Peroral Endoscopic Myotomy in a Woman with Large Epiphrenic Diverticulum: A Case Report and Literature Review

Parapneumonic Effusion and Tension Pneumothorax after Diverticular Peroral Endoscopic Myotomy in a Woman with Large Epiphrenic Diverticulum: A Case Report and Literature Review

Role of Peroral Endoscopic Myotomy (POEM) in the Management of Esophageal Diverticula

Minimizing complications after minimally invasive surgery for epiphrenic diverticula of the esophagus: technical tips

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