Peroral Endoscopic Myotomy for the Treatment of Esophageal Diverticula

Facciorusso, Antonio; Ramai, Daryl; Ichkhanian, Yervant; Yadlapati, Rena; Annese, Vito; Wani, Sachin; Khashab, Mouen A.

doi:10.1097/mcg.0000000000001622

Cited by 14 publications

(13 citation statements)

References 51 publications

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“…This approach was demonstrated to be safe, with no intra- or post-procedural complications, and was associated with a short hospital stay (median 1 day). Moreover, our technique was efficient, with a median procedure time of 60 minutes, which is shorter than published reports for alternative endoscopic techniques 12 13 .…”

Section: Discussionmentioning

confidence: 57%

Direct diverticular peroral endoscopic myotomy for the treatment of thoracic esophageal diverticula: technique and outcomes

Gauci,

Gupta,

Abu Arisha

et al. 2023

Endoscopy

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Background Diverticular peroral endoscopic myotomy (POEM) is an alternative to surgery for the management of symptomatic thoracic esophageal diverticula. Conventionally, this requires proximal tunnel formation but a direct approach may simplify the technique. Herein, we report the outcomes of direct diverticular-POEM (DD-POEM). Methods We conducted a single-center prospective observational study evaluating DD-POEM. This involved a direct approach to the diverticulum. Success was defined as an Eckardt score of ≤ 3 without the need for reintervention. Results 10 patients underwent DD-POEM (median age 72 years; interquartile range [IQR] 14.3; male 60 % [n = 6]). Median diverticulum size was 40 mm (IQR 7.5) and median location was 35 cm from the incisors (IQR 8.3). Five patients (50 %) had an underlying dysmotility disorder. The median procedure duration was 60 minutes (IQR 28.8). There were no adverse events. The median hospital stay was 1 day (IQR 0.75). The pre-procedure median Eckardt score of 6 (IQR 4) significantly improved to 0 (IQR 0.75; P < 0.001) at a median follow-up of 14.5 months (IQR 13.8). Success was achieved in all patients. Conclusions DD-POEM was a safe technique for the management of thoracic esophageal diverticula. Owing to its simplicity and excellent performance it should be further evaluated for the treatment of this disorder.

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Section: Discussionmentioning

confidence: 57%

Direct diverticular peroral endoscopic myotomy for the treatment of thoracic esophageal diverticula: technique and outcomes

Gauci,

Gupta,

Abu Arisha

et al. 2023

Endoscopy

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“…Surgery, even in minimally invasive variants such as thoracoscopy or laparoscopy, is associated with high morbidity (8%-23% risk of leaks or fistulas) and mortality (0%-7%) (18), which justifies the growing interest in using thirdspace endoscopy procedures. Most studies have evaluated the outcomes of diverticular POEM (D-POEM) for epiphrenic diverticula (EPD) (11,19), although case reports treating mid-esophageal (20) and Killian-Jamieson diverticula have also been published (21).…”

Section: D-poemmentioning

confidence: 99%

“…Evidence about D-POEM stems from retrospective and uncontrolled series of small sample size summarized in four recent meta-analyses (11,20,29,30). These metaanalyses indicate that the technical and clinical success rate is approximately 90%-100%, with a very low risk of recurrence (< 5-10%) and a favorable safety profile compared to surgery (≈ < 10% risk of serious AEs) (11,20,29,30). Perforation represents the most frequent serious AE, followed by bleeding (11).…”

Section: D-poemmentioning

confidence: 99%

POEM from A to Z: current perspectives

Albéniz¹,

Valenciano²,

Estremera-Arévalo³

et al. 2023

Rev Esp Enferm Dig

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“…POEM is a new endoscopy technique for the treatment of achalasia originating from 2008. POEM can be used also in esofageal conditions other than achalasia [ 14 ]. It is a form of per natural orifice transluminal endoscopic surgery that is completed by creating a submucosal tunnel in the lower part of esophagus to reach the inner circular muscle bundles of the LES to perform myotomy, while preserving the outer longitudinal muscle bundles.…”

Section: Introductionmentioning

confidence: 99%

Comparison of fully coated anti-reflux metal stenting and per-oral endoscopic myotomy in patients with achalasia: a propensity score-matched retrospective study

et al. 2022

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Background Achalasia is a rare primary esophageal motility disorder disease. It is reported that the long-term effect of fully coated anti-reflux metal stent (FCARMS) implantation is satisfactory. Operated by a skilled and experienced endoscopist, the effect of per-oral endoscopic myotomy (POEM) treatment is equivalent to that of surgical myotomy. So far, there is still few evidence to prove FCARMS implantation or POEM which is better for achalasia. The choice of treatment for achalasia is still controversial. The aim of this study is to find a more suitable therapy for achalasia by comparing the efficacy of FCARMS implantation and POEM. Methods A propensity score (PS) matching (1:2) was used in this retrospective cohort study. Data collected from consecutive patients of Achalasia, receiving FCARMS implantation or POEM therapy at the department of gastroenterology, the Seventh Medical Center of the Chinese People’s Liberation Army General Hospital from May 2007 to May 2018. According to their previous treatment, they are divided into two groups, FCARMS group and POEM group. Clinical efficacy and complications were compared between the two groups. Results A total of 166 cases were collected, including 113 cases of FCARMS and 53 cases of POEM. By PS matching, 150 patients were enrolled (100 cases of FCARMS and 50 cases of POEM). By comparison, the FCARMS group has shorter operation time, shorter fasting time and lower hospitalization costs than the POEM group (p < 0.05). Common complications in the FCARMS group are nausea, vomiting, and stent shift. Repetitions of gastroscopy in the FCARMS group was more often, which were 3.8 ± 2.4 (vs 2.1 ± 1.8 of POEM) (p = 0.00 < 0.05) The 6-month remission rates of the FCARMS combination POEM group were 89% and 94%, respectively (p = 0.39), and the 2-year remission rates were 61% and 90%, respectively (p = 0.00). Conclusions Stent placement is a cost-effective and safe treatment option for achalasia. The short-term effect (less than 6 months) of FCARMS is similar to that of POEM, the long-term effect (more than 2 years), POEM is better than FCARMS. HRMIIis most suitable for POEM treatment. It indicate that Patients can choose treatment methods according to their own conditions.

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Peroral Endoscopic Myotomy for the Treatment of Esophageal Diverticula

Cited by 14 publications

References 51 publications

Direct diverticular peroral endoscopic myotomy for the treatment of thoracic esophageal diverticula: technique and outcomes

Direct diverticular peroral endoscopic myotomy for the treatment of thoracic esophageal diverticula: technique and outcomes

POEM from A to Z: current perspectives

Comparison of fully coated anti-reflux metal stenting and per-oral endoscopic myotomy in patients with achalasia: a propensity score-matched retrospective study

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