Role of functional luminal imaging probe in the management of postmyotomy clinical failure

Ichkhanian, Yervant; Gutierrez, Olaya Brewer; Roman, Sabine; Yoo, In Kyung; Canakis, Andrew; Pawa, Rishi; Koch, Kenneth L.; Su, Bailey; Ujiki, Michael; Alsheik, Eva; Zuchelli, Tobias; Piraka, Cyrus; Ghandour, Bachir; Zhang, Linda; Sloan, Joshua A.; Khashab, Mouen A.

doi:10.1016/j.gie.2022.02.002

Cited by 8 publications

(2 citation statements)

References 32 publications

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“…After the careful interview of the patient and treatment of a potential GERD, a complete workup should be performed, including upper GI endoscopy, manometry, pH study and esophagogram. The role of FLIP has also been advocated in this indication ( 41 ). The type of persistent symptoms should be investigated, with retrosternal pain being the most difficult to treat.…”

Section: Management Of Per Oral Endoscopic Myotomy Failurementioning

confidence: 99%

Risk factors for clinical failure of peroral endoscopic myotomy in achalasia

et al. 2022

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The recent development of per oral endoscopic myotomy (POEM) has been a game changer in the management of patients with achalasia. However, approximately 1 in 10 patients will not experience clinical success. The aim of this mini-review is to describe the current state of knowledge about the risk factors associated with POEM failure for the treatment of achalasia. Suspected risk factors are detailed into pre-, intra-, and post-procedural factors and put into perspective. Pre-procedural factors have been described, such as pre-treatment Eckardt score, previous treatments for achalasia, sigmoid type esophagus, significant esophageal dilatation, non-type II achalasia, young age and long duration of symptoms. An intra-procedural factor, mucosal injury during POEM, has also been associated with POEM failure. The occurrence of post-POEM GERD was identified as a controversial post-procedural factor associated with failure. The presumed mechanisms of POEM failure are incomplete myotomy or ineffective LES disruption, as confirmed by high-resolution manometry. However, when manometry confirms a significant decrease in LES pressure, it is likely that either impaired peristalsis or a morphologic abnormality such as extreme esophageal dilatation or severe tortuosity, which are not treated by POEM, should be suspected. Notably, a recently described adverse effect of POEM is the formation of a pseudo-diverticulum at the site of the myotomy (blown out myotomy). We finally stress the importance of performing a complete workup in case of POEM failure as different mechanisms of POEM failure should lead to different management.

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Section: Management Of Per Oral Endoscopic Myotomy Failurementioning

confidence: 99%

Risk factors for clinical failure of peroral endoscopic myotomy in achalasia

et al. 2022

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“…A large retrospective study was conducted evaluating patients with failed LHM OR POEM [1]. HRM and FLIP were performed in all patients after treatment for achalasia was rendered with either modality.…”

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confidence: 99%