The current state of per oral endoscopic myotomy for achalasia

Smith, Shane P.; Louie, Brian E.

doi:10.21037/jovs.2017.07.11

Cited by 5 publications

(2 citation statements)

References 46 publications

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“…Since 2008, POEM has proven its efficacy in the treatment of achalasia and it is now considered an alternative first-line therapy by many. POEM can be offered for different esophageal diseases 20 21 22 23 24 25 , is cost-saving 26 , and provides a longer myotomy 21 , with similar long-term benefits as compared to HM 27 28 , while reducing post-procedural pain 29 . In addition, endoscopic myotomy has proven to be a promising technique folr other esophageal conditions, such as Jackhammer esophagus 30 and as a “salvation technique” for patients with recurrent symptoms after HM 31 32 33 .…”

Section: Discussionmentioning

confidence: 99%

How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective

et al. 2020

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Background and study aims Both Heller myotomy (HM) and per-oral endoscopic myotomy (POEM) are efficacious therapies for achalasia. The efficacy and safety of POEM vs HM in Latin America and specifically in patients with Chagas disease is unknown. Patients and methods Consecutive patients undergoing either HM or POEM for achalasia were included from nine Latin American centers in a prospective registry over 5 years. Technical success was defined as undergoing a successful myotomy. Clinical success was defined as achieving an Eckardt score < 3. Data on demographics, procedure info, Eckardt score, and adverse events (AEs) were collected. Student’s t test, Chi squared, and logistic regression analyses were conducted. Results One hundred thirty-three patients were included (59 male; 44 %; mean age 47). POEM was performed in 69 patients, HM in 64 patients. A total of 35 patients had Chagas disease, 17 of 69 in the POEM group, 18 of 64 in the HM group. Both groups had significant reduction in Eckardt scores (P < 0.00001), but successful initial therapy was significantly higher in the POEM group compared to the HM group (P = 0.01304). AEs were similar in both group (17 % vs 14 %) and consisted of pneumothorax (n = 3 vs 2), bleeding requiring transfusion (n = 3 vs 2), and mediastinitis (n = 3 vs 1). Hospital stay was longer in the HM group than in the POEM group (P < 0.00001). In the Chagas subgroup, post-procedure Eckardt score in the POEM group was significantly reduced by 5.71 points (P < 0.00001) versus 1.56 points in the HM group (P = 0.042793). Conclusion Both HM and POEM are efficacious for achalasia, but POEM was associated with higher initial therapy success and shorter hospital stay in Latin America. In Chagas patients with achalasia, POEM was significantly more effective than HM.

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Section: Discussionmentioning

confidence: 99%

How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective

et al. 2020

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“…Among these distally acting therapies, gastric peroral endoscopic pyloromyotomy (G-POEM) has recently been introduced as a promising, novel therapeutic modality (13)(14)(15)(16). This procedure involves a small endoscopic incision into the antral muscle to reduce tone and promote gastric emptying, using technical concepts similar to the per-oral endoscopic myotomy procedure for achalasia (17). Despite exciting initial results for G-POEM, a subset of patients have disease refractory to the procedure.…”

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confidence: 99%

Proximal and Distal Gastric Retention Patterns in Gastroparesis and the Impact of Gastric Per-Oral Endoscopic Myotomy: A Retrospective Analysis Using Gastric Emptying Scintigraphy

Spandorfer

Zhu

Abdelfatah

et al. 2019

J. Nucl. Med. Technol.

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Gastroparesis is a debilitating disease of insufficient gastric emptying and visceral hypersensitivity characterized by nausea, vomiting, early satiety, and bloating. Gastric emptying scintigraphy (GES), in combination with typical symptoms and normal esophagogastroduodenoscopy findings, is used to diagnose the disease. Gastric per-oral endoscopic pyloromyotomy (G-POEM) has emerged as a novel technique for treating gastroparesis, with up to an 80% success rate. This procedure involves myotomy of the distal stomach. We hypothesize that responders to this therapy are characterized by more distal dysmotility than nonresponders, as defined by GES retention patterns. Methods: We used regional gastric emptying measurements from diagnostic GES to determine the proximal or distal predominance of disease for each patient. We then compared treatment response and symptoms in each patient to total gastric half-emptying time (T ½ ), proximal gastric T ½ , and a ratio comparing the 2 values. Results: In total, 47 patients underwent G-POEM during the study period. A significant difference (P , 0.01) was found in proximal-to-total T ½ ratio between responders and nonresponders. A significant difference between pre-and postprocedural proximalto-total T ½ ratios was identified for each patient. No correlations were identified between motility patterns and symptoms or in motility patterns among the different etiologies of the disease. Conclusion: Proximal-to-total T ½ ratio may represent an important patient selection factor for G-POEM versus other treatment modalities going forward. Local retention patterns in GES may not inform the symptom profile in gastroparesis.

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