Submucosal Endoscopic Esophageal Myotomy: A Novel Experimental Approach for the Treatment of Achalasia

Pasricha, Pankaj J.; Hawari, Rami; Ahmed, Ijaz; Cotton, Peter B.; Gostout, Christopher J.; Hawes, Robert H.; Kalloo, Anthony N.; Kantsevoy, Sergey V.; Brining, Douglas

doi:10.1016/j.gie.2007.03.093

Cited by 88 publications

(112 citation statements)

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“…Initially described by Pasricha et al [41], this form of natural orifice transluminal endoscopic surgery (NOTES) has provided adequate symptom relief, shown similar shortterm results, and is less invasive as compared to laparoscopic Heller myotomy [42]. Short-term results have proven that POEM is a safe and effective approach for esophageal achalasia [43][44][45].…”

Section: Treatmentmentioning

confidence: 99%

Current status of achalasia management: a review on diagnosis and treatment

Tuason

Inoue

2017

J Gastroenterol

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Background Achalasia is a rare esophageal motility disorder that is characterized by loss of peristalsis and failure of relaxation of the lower esophageal sphincter (LES), particularly during swallowing. This review focuses on the diagnosis of esophageal motility disorders as defined by the Chicago Classification ver 3.0, and presents management options with regard to per-oral endoscopic myotomy (POEM) as the treatment of choice. Methods A concise review of literature was performed for articles related to the management of achalasia, and this was contrasted with our institution's current practice. Results Achalasia is still incompletely understood, and management is focused on establishing a proper diagnosis, and relieving the obstructive symptoms. Conclusions Achalasia should be considered when dysphagia is present, and not otherwise caused by an obstruction or inflammation, and when criteria is met as per the Chicago Classification ver 3.0. Lowering LES tone and disruption of LES can be accomplished by various methods, most notably pneumatic balloon dilatation and surgical myotomy. POEM has been gaining momentum as a first line therapy for achalasia symptoms, and can be considered an important tool for motility disorders of the esophagus.

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Section: Treatmentmentioning

confidence: 99%

Current status of achalasia management: a review on diagnosis and treatment

Tuason

Inoue

2017

J Gastroenterol

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“…First, the concept of submucosal access to reach the muscular layer (13) and second, the safety of the mucosal flap created during tunneling through the submucosal space (14). To create access in the submucosal tunnel, a biliary balloon was used to help dissect open the submucosa.…”

Section: Toward An Endoscopic Myotomymentioning

confidence: 99%

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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“…A new technique involving creating a submucosal tunnel in the lower esophagus followed by advancing the endoscope in the new created space to the lower esophageal sphincter (LES) and electrocautery disruption of circular muscle of LES was proven feasible in an animal model [71]. This technique was proven successful in 17 patients with achalasia who underwent endoscopic myotomy in a tertiary referral center in Japan.…”

Section: Endoscopic Myotomy For Esophageal Achalasiamentioning

confidence: 99%