POEM, GPOEM, and ZPOEM

Prospective study on the efficacy of endoscopic through-the-scope tack and suture system for gastric peroral endoscopic myotomy mucosal incision site closure

“…The gastric mucosa is thicker than in other parts of the GI tract, which increases the difficulty of securely grasping and approximating the incision margins. The closure method for the mucosal incision is often dependent on the orientation of the mucosotomy [3].…”

Third-space endoscopy: the final frontier

“…POEM was associated with a higher sustained response when compared with PD (92% vs 54%; P < 0.01) at 24 months and no statistically significant difference in the rate of serious adverse events (0% with POEM and 3% with PD) [ 39 ]. Similarly, comparative observational data have consistently shown similar or superior clinical efficacy of POEM vs Heller myotomy (HM) [ 40 ]. Subsequently, the landmark multicenter randomized trial comparing POEM vs HM in patients with idiopathic achalasia demonstrated similar clinical success rates (83% and 82%) at 2-year follow-up between the two treatment modalities [ 41 ].…”

“…A recent multicenter retrospective study showed high clinical response (94%) to POEM in patients with EGJOO at a median follow-up of 117 days [ 45 ]. However, it should be noted that EGJOO is a very heterogenous disorder that can be frequently overdiagnosed [ 40 ]. Overall, high-quality studies are currently lacking, and POEM should only be considered for the treatment of symptomatic non-achalasia spastic esophageal disorders after an extensive and careful multidisciplinary diagnostic evaluation and after other less invasive measures have been exhausted.…”

“…Submucosal tunneling is then initiated and continued until identification of the pylorus. As opposed to E-POEM, submucosal tunneling can be technically more challenging due to several factors, including looping of the endoscope in the distal stomach, the curving/deflection of the tunnel towards the pyloric ring, and the less discernible anatomic landmarks [ 40 ]. Hence, withdrawing the endoscope into the lumen and reinsertion into the submucosal tunnel is usually performed several times so as to ensure progression in the right direction towards the pylorus muscle.…”

“…Once the pylorus is identified, a 2- to 3.5-cm myotomy is performed [ 57 ]. Technical variations on the myotomy (partial vs full-thickness, “single vs double” myotomy, width of the myotomy) have been proposed yet high-quality data are lacking [ 40 , 58 , 59 ]. Upon completion of the myotomy, mucosal closure can be performed with either endoscopic clips or suturing.…”