POEM for Esophageal Achalasia

Abstract

Over the past decade, per-oral endoscopic myotomy has been shown to be a durable minimally invasive approach to the treatment of esophageal achalasia. Patients with suspected achalasia should undergo upper endoscopy, timed barium esophagram, and high-resolution manometry to confirm the diagnosis. The procedure includes several key steps including mucosotomy, submucosal tunneling, selective myotomy of the circular muscle layer, and mucosotomy closure. Specialized endoscopic dissection tools are used during the procedure to access the submucosal space. Common procedural challenges include minor bleeding and capnoperitoneum.

Tunnel endoscopic interventions in esophageal diseases

“…К безусловным преимуществам данных операции можно отнести их малую инвазивность, хороший косметический эффект, низкую частоту послеоперационных осложнений и возможность их эндоскопической коррекции, быструю реабилитацию и хороший клинический результат [1,4,10,13].…”

“…По мере накопления опыта этих вмешательств, появляются публикации, формирующие мировые тенденции в лечении пациентов с подслизистыми опухолями пищевода и ахалазией кардии [2,4,6,10,11].…”

“…Современное развитие гастроинтестинальной эндоскопии позволяет выполнять малоинвазивные вмешательства в любых отделах желудочнокишечного тракта, не прибегая к применению лапароскопии [1]. Эндоскопия третьего пространства с туннельными операциями прочно закрепила свои позиции в лечении пациентов с подслизистыми опухолями пищевода, ахалазией кардии [2][3][4][5]. Большое количество публикации показывают высокую эффективность вмешательств, вместе с тем, указывая на их возможности и недостатки [6][7][8][9][10][11].…”

Robotic Heller-Dor myotomy: 10-year monocentric experience compared with POEM

“…Besides, patients are safely given liquid diet in POD 1 and solid diet in POD 2 and they are discharged on POD 3. Post-procedural care after POEM is different according to clinicians' attitude: some practitioners perform gastrografin swallow study to check integrity of mucosal suture and give patients soft diet for at least two weeks before starting a regular diet; others discharge patients on POD 1, even if some patients feel well enough to leave in the evening; they reserve X-ray with gastrografin swallow to patients complaining with more pain than expected, in case of dysphagia persistence or challenging mucosal suturing [8]. It is evident that post-operative management after RAHD is more standardized in Italy and worldwide, as a consequence not only of the longer experience with this approach but also of the low probability to incur late complications such as bleeding or perforation which, on the other hand, may occur with clips abruption after POEM.…”

“…Recent advantages in endoscopic procedures, which are even less invasive and painful than surgical interventions performed laparoscopically, have introduced a novel technique of Per-Oral Endoscopic Miotomy (POEM) among the therapeutic options for achalasia. It is an advanced endoscopic procedure which consists in creating a submucosal tunnel from the middle third of the esophagus to the proximal stomach, followed by a myotomy extended from 2 cm below initial mucosal incision towards the cardia [8,9]. At the beginning POEM was criticized for the absence of any anti-reflux valve system confection, which may result in post-procedural gastro-esophageal reflux occurrence.…”