Two penetrating vessels as a novel indicator of the appropriate distal end of peroral endoscopic myotomy

Tanaka, Shinwa; Kawara, Fumiaki; Toyonaga, Takashi; Inoue, Haruhiro; Bechara, Robert; Hoshi, Namiko; Abe, Hironori; Ohara, Yoshiko; Ishida, Tatsuro; Morita, Yoshinori; Umegaki, Eiji

doi:10.1111/den.12957

Cited by 50 publications

(30 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Because POEM is carried out from inside the esophagus, it is more difficult to determine whether the surgery is being done on the gastric side, compared with Heller myotomy. As a result of this, the techniques below are used to verify that the surgery is proceeding on the gastric side . The double‐scope method is particularly useful because it allows direct vision to verify that the myotomy extends down to the stomach …”

Section: Clinical Questions and Statementsmentioning

confidence: 99%

Clinical practice guidelines for peroral endoscopic myotomy

Inoue

Shiwaku

Iwakiri

et al. 2018

Digestive Endoscopy

Self Cite

126

155

View full text Add to dashboard Cite

Peroral endoscopic myotomy (POEM) is a novel clinical technique developed in Japan used to treat esophageal achalasia and esophageal motility disorders. This technique has been rapidly accepted and widely disseminated throughout our clinical practice because of its low invasiveness, technical novelty, and high efficacy. Since the advent of POEM, there have been no clinical guidelines that clearly indicated its standard of care, and these guidelines have been anticipated both nationally and internationally by clinicians who engage in POEM practice. In 2017, to meet these needs, the Japan Gastroenterological Endoscopy Society (JGES) launched the guideline committee for POEM. Based on the guideline development process proposed by the Medical Information Network Distribution Service (MINDS), the guideline committee initially created research questions on POEM and conducted a systematic review and meta-analysis on each topic. The clinical research extracted from databases for these clinical questions and the systematic review mainly comprised a few retrospective studies with a small number of participants and short trial periods; hence, the strength of the evidence and recommendations derived from these results was low. Throughout this process, the guideline committee met thrice: once on May 13, 2017, and again on September 17, 2017, to formulate the draft. A consensus meeting was then held on January 14, 2018, in Tokyo to establish the guideline statements and finalize the recommendations using the modified Delphi method. This manuscript presents clinical guidelines regarding current standards of practice and recommendations in terms of the nine chief topics in POEM.

show abstract

Section: Clinical Questions and Statementsmentioning

confidence: 99%

Clinical practice guidelines for peroral endoscopic myotomy

Inoue

Shiwaku

Iwakiri

et al. 2018

Digestive Endoscopy

Self Cite

126

155

View full text Add to dashboard Cite

show abstract

“…Depending on the orientation of the submucosal tunnel, it was possible to observe a part of the oblique muscle and the large branch of the left gastric artery in some patients, indicating that the scope was within the lesser curvature of the stomach. 24 Endoscope resistance: When creating the submucosal tunnel, it is possible to note the narrowing of the esophageal lumen closer to the LES, which then opens wide into the stomach. When the endoscope is inserted into the stomach cavity after the myotomy is completed, it is possible to feel decreased resistance at the LES.…”

Section: Injection Methods 9 : Indocyanine Green Solution Wasmentioning

confidence: 99%

Peroral endoscopic myotomy for achalasia: a prospective multicenter study in Japan

Shiwaku

Inoue

Sato

et al. 2020

Gastrointestinal Endoscopy

Self Cite

View full text Add to dashboard Cite

Background and Aims: Peroral endoscopic myotomy (POEM) is an available treatment modalities for achalasia. The reported efficacy of POEM in the only prospective multicenter study was 82%; however, a retrospective multicenter study in Japan reported a higher efficacy rate of 95%. The aim of this study was to prospectively verify treatment outcomes after POEM at multiple facilities in Japan. Methods: This was a prospective single-arm trial of POEM for achalasia at 8 facilities in Japan between April 2016 and March 2018 to evaluate its safety and efficacy. Patients were re-evaluated at 3 months and up to 1 year after POEM. Results: Among the 233 patients with achalasia who underwent POEM, procedure-related adverse events occurred in 24 patients (10.3%), none of whom required surgical intervention. In the 207 patients satisfying the inclusion criteria, the efficacy rate of POEM, defined by an Eckardt score 3 at 1 year, was 97.4% (95% CI, 95.3%-99.7%). The Eckardt score decreased significantly from 6.6 AE 2.0 preoperatively to 1.1 AE 1.1, 1 year after POEM. Postoperative reflux esophagitis, severe reflux esophagitis, and symptomatic GERD were reported in 54.2%, 5.6%, and 14.7%, respectively, and proton pump inhibitors were administered in 21.1%. Conclusions: Our prospective multicenter study in Japan showed greater efficacy of POEM for achalasia compared with the results of a previous prospective multicenter study. POEM is safe and highly effective for at least 1 year.

show abstract

“…35 One of the problems during POEM is ensuring the appropriate length of myotomy on the gastric side. Tanaka et al 36 reported that the two penetrating vessels in the gastric cardia are a simple and reliable indicator of the appropriate distal end of myotomy. In addition, prevention of gastroesophageal reflux (GER) after POEM is also an issue, and Inoue et al 37 reported POEM+F in which endoscopic fundoplication is performed after POEM.…”

Section: Current Status Of Therapeutic Endoscopy For Gastric Lesionsmentioning

confidence: 99%

Innovative therapeutic endoscopy in the upper gastrointestinal tract: Review of Japan Gastroenterological Endoscopic Society Core Sessions

Yamamoto

Yahagi

Yamamoto

et al. 2020

Digestive Endoscopy

Self Cite

View full text Add to dashboard Cite

Workshops on "Innovative Therapeutic Endoscopy" for upper gastrointestinal tract diseases were held four times as the Japan Gastroenterological Endoscopic Society (JGES) Core Sessions at the 93rd to 96th Biannual Meetings of the JGES. A total of 48 research presentations (including two invited lectures) were reported, and various discussions were held on these topics. When the research presentations were categorized according to the therapeutic procedure, endoscopic submucosal dissection (ESD) was the most frequent with 28 presentations (58.3%), followed by laparoscopy endoscopy cooperative surgery (LECS) with six presentations (12.5%). When the research presentations were classified by the target organ of the therapeutic procedures, the duodenum was the most frequent with 26 presentations (54.1%), followed by the stomach with 13 presentations (27.1%). The most important issue was the establishment of a safe and reliable endoscopic resection method for duodenal lesions. Issues related to gastric ESD were establishing an efficient traction method and a method to prevent post‐ESD bleeding in high‐risk patients. Other important issues were establishment of an efficient traction method and methods of preventing delayed bleeding in high‐risk patients who undergo gastric ESD, expansion of indications for minimally invasive treatment using LECS for gastric cancer, the development of endoscopic full‐thickness resection (EFTR) for gastric submucosal tumors (SMTs), and improvement of per‐oral endoscopic myotomy (POEM) for esophageal achalasia and per‐oral endoscopic tumor resection (POET) for esophageal SMTs. Through the JGES Core Sessions, it is expected that the minimally invasive treatments using endoscopes developed in Japan will be further advanced.

show abstract

Two penetrating vessels as a novel indicator of the appropriate distal end of peroral endoscopic myotomy

Abstract: TPVs appears to be a simple and reliable indicator to determine the appropriate distal end of myotomy.

Cited by 50 publications

References 18 publications

Clinical practice guidelines for peroral endoscopic myotomy

Clinical practice guidelines for peroral endoscopic myotomy

Peroral endoscopic myotomy for achalasia: a prospective multicenter study in Japan

Innovative therapeutic endoscopy in the upper gastrointestinal tract: Review of Japan Gastroenterological Endoscopic Society Core Sessions

Contact Info

Product

Resources

About