Repeat peroral endoscopic myotomy: a salvage option for persistent/recurrent symptoms

Li, Quan‐Lin; Yao, Liang; Xu, Xiaoyue; Zhu, Junyu; Xu, Mei‐Dong; Zhang, Yiqun; Chen, Weifeng; Zhou, Ping‐Hong

doi:10.1055/s-0034-1393095

Cited by 42 publications

(60 citation statements)

References 21 publications

(25 reference statements)

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“…Re – POEM was successfully performed in 3 patients with 100 % clinical success at 1-year follow-up. Repeat POEM appears safe and effective as a salvage option after initial POEM failure 25.…”

Section: Discussionmentioning

confidence: 95%

Per-oral endoscopic myotomy for achalasia cardia: outcomes in over 400 consecutive patients

et al. 2017

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Background and study aims Per-oral endoscopic myotomy (POEM) has emerged as an efficacious treatment modality for the management of achalasia cardia (AC) and non-achalasia spastic esophageal motility disorders. Initial results are encouraging. We analyzed the safety and efficacy of POEM in a large cohort of patients with AC. Patients and methods The data from patients who underwent POEM (from January 2013 to June 2016) was prospectively collected and analyzed. Clinical success was defined as Eckardt score ≤ 3 after POEM procedure. Objective parameters including high-resolution manometry (HRM) and timed barium swallow (TBS) were analyzed and compared before and after the procedure. Gastroesophageal reflux was analyzed using 24-hour pH impedance study and esophagogastro-duodenoscopy. Results A total of 408 patients (mean age 40 years, range 4 – 77 years) underwent POEM during the specified period. POEM could be successfully completed in 396 (97 %) patients. Clinical success rates at 1, 2 and 3 years were 94 %, 91 % and 90 %, respectively. Mean Eckardt score was 7.07 ± 1.6 prior to POEM and 1.27 ± 1.06 after POEM (P = 0.001) at 1 year. Significant improvement in esophageal emptying on TBE (> 50 %) was documented in 93.8 % patients who completed 1-year follow up. Pre-procedure and post-procedure mean lower esophageal sphincter pressure was 45 ± 16.5 mmHg and 15.6 ± 6.1 mmHg, respectively (P = 0.001). Technical and clinical success were comparable in naïve vs prior treated cases (97.3 % vs 96.8 %, P = 0.795) (95.7 % vs 92.6 %, P = 0.275). GERD was documented in 28.3 % patients with 24-hour pH-impedance study and erosive esophagitis was seen in 18.5 % of patients who underwent POEM. Conclusions POEM is safe, effective and has a durable response in patients with achalasia cardia. Prior treatment does not influence the outcomes of POEM.

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Section: Discussionmentioning

confidence: 95%

Per-oral endoscopic myotomy for achalasia cardia: outcomes in over 400 consecutive patients

et al. 2017

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“…Li et al . evaluated the feasibility, safety and efficacy of re‐POEM as a rescue treatment, showing that 15 patients with prior POEM failure underwent re‐POEM successfully after a mean follow‐up duration of 13.5 months. The rate of reflux after re‐POEM was reported to be 33.3%.…”

Section: Special Achalasiamentioning

confidence: 99%

POEM for special patient cohorts: A review

Zhang

et al. 2017

J of Digest Diseases

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Peroral endoscopic myotomy (POEM) is a natural orifice, translumenal endoscopic surgical procedure that achieves endoscopic myotomy by conducting a submucosal tunnel as an operating space. It is conventionally performed in achalasia. Recently, several centers worldwide have reported the feasibility of this procedure not only in early achalasia but also in other particular patient cohorts. Possible indications for POEM include previously failed Heller myotomy, pneumatic balloon dilatation or POEM, sigmoid achalasia, pediatric patients, spastic esophagus disorders, Zenker's diverticulum and gastroparesis. However, its application in large numbers of special patient groups awaits knowledge of the long-term outcome and greater experience with POEM.

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“…Treatment options for patients not responding to primary POEM could be to perform a re‐do POEM . When the muscle spasm is located in the proximal esophagus, conventional POEM is difficult, because of the limited access and requirement of a safe distance of the myotomy from the upper esophageal sphincter (UES).…”

Section: Introductionmentioning

confidence: 99%

Navigated retrograde endoscopic myotomy (REM) for the treatment of therapy‐resistant achalasia

Pham

Havre

Langø

et al. 2017

Neurogastroenterology Motil

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Repeat peroral endoscopic myotomy: a salvage option for persistent/recurrent symptoms

Abstract: Re-POEM appears safe and effective as a salvage option after initial POEM failure, conferring short-term symptom relief and being free of serious complications in all patients.

Cited by 42 publications

References 21 publications

Per-oral endoscopic myotomy for achalasia cardia: outcomes in over 400 consecutive patients

Per-oral endoscopic myotomy for achalasia cardia: outcomes in over 400 consecutive patients

POEM for special patient cohorts: A review

Navigated retrograde endoscopic myotomy (REM) for the treatment of therapy‐resistant achalasia

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