Safety and efficacy of POEM for treatment of achalasia: a systematic review of the literature

Crespin, Oscar M.; Liu, Louis W. C.; Parmar, Ambica; Jackson, Timothy; Hamid, Jemila S.; Shlomovitz, Eran; Okrainec, Allan

doi:10.1007/s00464-016-5217-y

Cited by 90 publications

(51 citation statements)

References 73 publications

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“…In the large retrospective study previously mentioned, delayed mucosal closure failure occurred in 0.8%, delayed bleeding in 0.2%, hydrothorax requiring intervention in 0.5%, pneumothorax requiring intervention in 1.5% (32). A review of multiple outcome reports showed similar percentages and also identified pneumomediastinum, pneumoperitoneum, and subcutaneous emphysema as common post-operative findings (33). Many of these issues are minimized with the use of carbon dioxide insufflation, which allows for quicker dissipation of excess gas (34).…”

Section: Complicationsmentioning

confidence: 66%

“…Many of these issues are minimized with the use of carbon dioxide insufflation, which allows for quicker dissipation of excess gas (34). Obviously, there is the issue of a learning curve with outcome reports from single centers and as surgeons master the POEM procedure complications should decrease in rate and surveillance of risk factors improves (32,33).…”

Section: Complicationsmentioning

confidence: 99%

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The current state of per oral endoscopic myotomy for achalasia

Smith

Louie

2017

J. Vis. Surg.

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Achalasia is an acquired neuromuscular disorder that has been treated using a variety of modalities throughout medical history. Recently, the technique of per oral endoscopic myotomy (POEM) was introduced to treat the disease using a truly minimally invasive, natural orifice technique that is rapidly being adopted across the world. This review outlines the development of POEM, the technique itself, and gives a comparison to other procedures, specifically laparoscopic Heller myotomy (LHM).

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Section: Complicationsmentioning

confidence: 66%

Section: Complicationsmentioning

confidence: 99%

The current state of per oral endoscopic myotomy for achalasia

Smith

Louie

2017

J. Vis. Surg.

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“…Several published systemic reviews and meta‐analyses suggest that POEM has equal or higher efficacy as compared with LHM at least in short‐term . However, all the published meta‐analyses are limited by absence of long‐term follow up and lack of prospective randomized controlled studies.…”

Section: Methodsmentioning

confidence: 99%

“…31 Several published systemic reviews and meta-analyses suggest that POEM has equal or higher efficacy as compared with LHM at least in short-term. [31][32][33][34][35][36][37][38][39][40][41] However, all the published metaanalyses are limited by absence of long-term follow up and lack of prospective randomized controlled studies. As the first procedure was performed less than a decade ago, long term follow-up studies of POEM are not available.…”

Section: Quality Of Evidence: 2++ Classification Of Recommendation: Bmentioning

confidence: 99%

Management of achalasia cardia: Expert consensus statements

Ramchandani

Reddy

Nabi

et al. 2018

J of Gastro and Hepatol

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Achalasia cardia (AC) is a frequently encountered motility disorder of the esophagus resulting from an irreversible degeneration of neurons. Treatment modalities are palliative in nature, and there is no curative treatment available for AC as of now. Significant advancements have been made in the management of AC over last decade. The introduction of high resolution manometry and per-oral endoscopic myotomy (POEM) has strengthened the diagnostic and therapeutic armamentarium of AC. High resolution manometry allows for the characterization of the type of achalasia, which in turn has important therapeutic implications. The endoscopic management of AC has been reinforced with the introduction of POEM that has been found to be highly effective and safe in palliating the symptoms in short-term to mid-term follow-up studies. POEM is less invasive than Heller's myotomy and provides the endoscopist with the opportunity of adjusting the length and orientation of esophageal myotomy according to the type of AC. The management of achalasia needs to be tailored for each patient, and the role of pneumatic balloon dilatation, POEM, or Heller's myotomy needs to be revisited. In this review, we discuss the important aspects of diagnosis as well as management of AC. The statements presented in the manuscript reflect the cumulative efforts of an expert consensus group.

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“…A recent review of 19 studies, including about 1,300 cases of POEM, found an overall rate of gas-related complications of 36%. Complications were distributed as follows: 17% were pneumoperitoneum, 5% were pneumothorax, 4% were pneumomediastinum, and 10% were subcutaneous emphysema [26]. Moreover, complications were usually clinically irrelevant and without any hemodynamic or respiratory consequences.…”

Section: Gas-related Complicationsmentioning

confidence: 99%