Peroral Endoscopic Myotomy for the Treatment of Achalasia: A Prospective Single Center Study

Renteln, Daniel von; Inoue, Haruhiro; Minami, Hiromi; Werner, Yuki B.; Pace, Andrea; Kersten, Jan Felix; Much, Chressen; Schachschal, Guido; Mann, Oliver; Keller, Jutta; Fuchs, Karl–Hermann; Rösch, Thomas

doi:10.1038/ajg.2011.388

Cited by 319 publications

(202 citation statements)

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“…18,19 Recently developed POEM is also effective in lowering LES pressure, but requires longer follow-up and needs to be compared with PD or surgical myotomy. 17,[20][21][22] The most popular protocol of PD is a graded dilatation starting with a 3.0 cm, followed by 3.5 cm and then 4.0 cm balloon, in subsequent sessions balloon. 23 In our institution, a single dilatation with a 3.0 cm balloon is performed as the initial treatment and additional PD is performed according to an "on demand" strategy, based on symptom recurrence during follow-up.…”

Section: Discussionmentioning

confidence: 99%

Association Between Gastroesophageal Reflux Disease After Pneumatic Balloon Dilatation and Clinical Course in Patients With Achalasia

Lee

et al. 2014

J Neurogastroenterol Motil

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Background/AimsThe occurrence of gastroesophageal reflux disease (GERD) is known to be associated with lower post-treatment lower esophageal sphincter pressure in patients with achalasia. This study aimed to elucidate whether GERD after pneumatic balloon dilatation (PD) has a prognostic role and to investigate how the clinical course of GERD is. MethodsA total of 79 consecutive patients who were first diagnosed with primary achalasia and underwent PD as an initial treatment were included in this retrospective study. Single PD was performed using a 3.0 cm balloon. The patients were divided into two groups: 1) who developed GERD after PD (GERD group) and 2) who did not develop GERD after PD (non-GERD group). GERD was defined as pathological acid exposure, reflux esophagitis or typical reflux symptoms. ResultsTwenty one patients (26.6%) developed GERD after PD during follow-up. There were no significant differences between the two groups in demographic or clinical factors including pre-and post-treatment manometric results. All patients in GERD group were well responsive to maintenance proton pump inhibitor therapy including on demand therapy or did not require maintenance. During a median follow-up of 17.8 months (interquartile range, 7.1-42.7 months), achalasia recurred in 15 patients (19.0%). However, the incidence of recurrence did not differ according to the occurrence of GERD after PD. ConclusionsGERD often occurs after even a single PD for achalasia. However, GERD after PD is well responsive to PPI therapy. Our data suggest that GERD after PD during follow-up does not appear to have a prognostic role.

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Section: Discussionmentioning

confidence: 99%

Association Between Gastroesophageal Reflux Disease After Pneumatic Balloon Dilatation and Clinical Course in Patients With Achalasia

Lee

et al. 2014

J Neurogastroenterol Motil

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“…Initially described by Pasricha et al [41], this form of natural orifice transluminal endoscopic surgery (NOTES) has provided adequate symptom relief, shown similar shortterm results, and is less invasive as compared to laparoscopic Heller myotomy [42]. Short-term results have proven that POEM is a safe and effective approach for esophageal achalasia [43][44][45]. The patient is placed in a supine position under general anesthesia [46].…”

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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“…С 2014 г. в клинике мы стали внедрять новый метод лечения в России -эн-доскопическую кардиомиотомию, известную в зарубежной литературе как peroral endoscopic myotomy (POEM) [3,18,19]. Методика заключается в формировании ка-нала в подслизистом слое, в зоне повышенного тонуса пищевода и рассечении цир-кулярного мышечного слоя.…”

Section: материал и методыunclassified

Different Endoscopic Treatment Options in the Management of Achalasia

Korolev¹,

Fedotov²,

Spesivtsev³

et al. 2016

Vestnik SPbSU. Series 11. Medicine

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РАЗЛИЧНЫЕ ЭНДОСКОПИЧЕСКИЕ МЕТОДЫ ЛЕЧЕНИЯ АХАЛАЗИИ КАРДИИГородская Мариинская больница, Российская Федерация, 194104, Санкт-Петербург, Литейный пр., 56 В статье представлен оптимальный алгоритм обследования больных с подозрением на аха-лазию кардии. Для установления диагноза использовали рентгенологический метод исследо-вания, МСКТ органов грудной клетки, верхнего этажа брюшной полости и эндоскопический метод исследования. Все используемые методы позволяют своевременно и правильно устано-вить диагноз и стадию развития заболевания. При стадировании заболевания использована классификация, предложенная Б. В. Петровским (1962 г.). Рассмотрены результаты лечения ахалазии кардии посредством эндоскопической баллонной дилатации, направленной на рас-ширение нижнего пищеводного сфинктера, введение ботулинического токсина, что способ-ствует снижению тонуса кардии, малоинвазивные эндоскопические методики в сочетании с медикаментозной терапией, а также хирургическое лечение больных с IV стадией заболе-вания, которое позволяет получить хороший и удовлетворительный клинический результат лечения у 98,2 % больных. Также в статье представлен совершенно новый в Российской Фе-дерации эндоскопический метод лечения ахалазии кардии -пероральная эндоскопическая миотомия (POEM, peroral esophageal myotomy In this article, we showed the optimal examination schedule in patients with suspected achalasia. Th e diagnostic algorithm of achalasia included X-ray, multispiral computed tomography (MSCT) of the chest and upper abdomen and endoscopic examination methods. All these methods allowed for establishing the exact diagnosis and precise stage of the disease. Th e most common classifi cation for achalasia staging in the Russian Federation is the classifi cation proposed by Petrovskiy B. V. in 1962 which is based on the interpretation of X-ray imaging results because of their simplicity and availability. In this study we also showed diff erent treatment options such as an endoscopic balloon pneumatic dilation used to relieve the obstruction by mechanical disrupting, botulinum toxin injection directed to reduce pressure of the lower esophageal sphincter, minimally invasive interventions with pharmacological therapy, and surgical treatment for patients with IV stage of the disease that may benefi t in 98,2% of those patients. Additionally we showed clinical results of an absolutely new treatment method of endoscopic managing achalasia in the Russian Federation: oral esophageal myotomy (POEM) used in our clinic since 2014. It is a promising and minimally invasive option for treating achalasia. However, it still requires more data and assessment of clinical effi cacy. Refs 19. Figs 8. Keywords: Achalasia, endoscopic balloon pneumatic dilation, botulinum toxin injection, peroral endoscopic myotomy (POEM). ВведениеВ структуре хирургических заболеваний пищевода ахалазия кардии занима-ет 3-е место после онкологических заболеваний и рубцовых стриктур, составляя 3,1-20 % всех заболеваний пищевода [4].

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Peroral Endoscopic Myotomy for the Treatment of Achalasia: A Prospective Single Center Study

Abstract: POEM is a promising new treatment for achalasia resulting in short-term symptom relief in >90% of cases. Studies evaluating long-term efficacy and comparing POEM with established treatments have been initiated.

Cited by 319 publications

References 13 publications

Association Between Gastroesophageal Reflux Disease After Pneumatic Balloon Dilatation and Clinical Course in Patients With Achalasia

Association Between Gastroesophageal Reflux Disease After Pneumatic Balloon Dilatation and Clinical Course in Patients With Achalasia

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

Different Endoscopic Treatment Options in the Management of Achalasia

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