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Per oral endoscopic myotomy

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https://www.readbyqxmd.com/read/29353638/submucosal-surgery-novel-interventions-in-the-third-space
#1
REVIEW
Ezra N Teitelbaum, Lee L Swanstrom
Traditional surgeries involve accessing body cavities, such as the abdomen and thorax, via incisions that divide skin and muscle. These operations result in postoperative pain and convalescence, and a risk of complications such as wound infection and hernia. The development of flexible endoscopy allowed diseases as varied as gastrointestinal bleeding and colon adenomas to be treated without incisions, but this technique is restricted by its endoluminal nature. A novel category of surgical endoscopic procedures has recently been developed that uses flexible endoscopic techniques to enter and access the submucosa of the gastrointestinal tract...
February 2018: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29349541/per-oral-endoscopic-myotomy-early-experience-and-safety-of-a-multispecialty-approach
#2
Evgeny V Arshava, Raffaele J Marchigiani, Henning Gerke, Rami El Abiad, Ronald J Weigel, Kalpaj R Parekh, John Keech
BACKGROUND: Per oral endoscopic myotomy (POEM) has gained increasing popularity for treating achalasia. A multidisciplinary approach may allow safe and early adoption of POEM into clinical practice. MATERIALS AND METHODS: We performed a retrospective review of our initial POEM cases. All procedures were performed by a team of interventional gastroenterologist and thoracic surgeon. We analyzed demographics, comorbidities, achalasia subtypes, length of hospital stay, duration of surgery, morbidity, mortality, length of myotomy, preoperative and postoperative Eckardt scores...
January 18, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29340927/achalasia-cardia-in-a-young-infant
#3
V Poornachand, K Kumarasamy, S P Karamath, V Seenivasan, Sumathi Bavanandam, Nirmala Dheivamani
Achalasia cardia is an esophageal motility disorder rarely reported in children and more so in young infants. Common clinical presentations include vomiting, dysphagia, regurgitation, recurrent pulmonary aspiration and failure to thrive. Diagnosis is made by barium swallow study and esophageal manometry, which is the gold standard test. Pharmocological management and endotherapy often fails and results in recurrence of symptoms. Laparoscopic Hellers myotomy, with or without anti-reflux procedure is the standard treatment of choice for children...
January 17, 2018: Indian Journal of Pediatrics
https://www.readbyqxmd.com/read/29241847/recurrent-symptoms-after-per-oral-endoscopic-myotomy-in%C3%A2-achalasia-redo-dilate-or-operate-a-call-for-a%C3%A2-tailored%C3%A2-approach
#4
EDITORIAL
Ming-Ming Xu, Michel Kahaleh
No abstract text is available yet for this article.
January 2018: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29228523/advanced-therapeutic-gastrointestinal-endoscopy-in-children-today-and-tomorrow
#5
Zaheer Nabi, Duvvur Nageshwar Reddy
Gastrointestinal (GI) endoscopy plays an indispensable role in the diagnosis and management of various pediatric GI disorders. While the pace of development of pediatric GI endoscopy has increased over the years, it remains sluggish compared to the advancements in GI endoscopic interventions available in adults. The predominant reasons that explain this observation include lack of formal training courses in advanced pediatric GI interventions, economic constraints in establishing a pediatric endoscopy unit, and unavailability of pediatric-specific devices and accessories...
December 12, 2017: Clinical Endoscopy
https://www.readbyqxmd.com/read/29218664/cost-effectiveness-of-per-oral-endoscopic-myotomy-relative-to-laparoscopic-heller-myotomy-for-the-treatment-of-achalasia
#6
Erin K Greenleaf, Joshua S Winder, Christopher S Hollenbeak, Randy S Haluck, Abraham Mathew, Eric M Pauli
BACKGROUND: Per oral endoscopic myotomy (POEM) has recently emerged as a viable option relative to the classic approach of laparoscopic Heller myotomy (LHM) for the treatment of esophageal achalasia. In this cost-utility analysis of POEM and LHM, we hypothesized that POEM would be cost-effective relative to LHM. METHODS: A stochastic cost-utility analysis of treatment for achalasia was performed to determine the cost-effectiveness of POEM relative to LHM. Costs were estimated from the provider perspective and obtained from our institution's cost-accounting database...
December 7, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/29144018/navigated-retrograde-endoscopic-myotomy-rem-for-the-treatment-of-therapy-resistant-achalasia
#7
K D Pham, R F Havre, T Langø, E F Hofstad, G A Tangen, R Mårvik, T Pham, O H Gilja, J G Hatlebakk, A Viste
BACKGROUND: In achalasia, muscle spasm may involve the proximal esophagus. When the muscle spasm is located in the proximal esophagus, conventional per oral endoscopic myotomy (POEM) may not be sufficient to relieve symptoms. In this paper, we describe retrograde endoscopic myotomy (REM) as a novel approach to perform myotomy of the proximal esophagus, with the application of a navigation tool for anatomical guidance during REM. We aim to evaluate the feasibility and safety of REM and usefulness of the navigation during REM...
November 16, 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/29122601/per-oral-endoscopic-myotomy-in-patients-with-or-without-prior%C3%A2-heller-s-myotomy-comparing-long-term-outcomes-in-a-large-u-s-single-center-cohort-with-videos
#8
Xiaocen Zhang, Rani J Modayil, David Friedel, Krishna C Gurram, Collin E Brathwaite, Sharon I Taylor, Maria M Kollarus, Sony Modayil, Bhawna Halwan, James H Grendell, Stavros N Stavropoulos
BACKGROUND AND AIMS: Heller's myotomy (HM) is one of the most effective treatments for esophageal achalasia. However, failures do exist, and the success rate tends to decrease with time. The efficacy of rescue treatments for patients with failed HM is limited. A few small-scale studies have reported outcomes of per-oral endoscopic myotomy (POEM) in these patients. We conducted this study to systematically assess feasibility, safety, and efficacy of POEM on patients who have had HM. METHODS: Patients at least 3 months out from POEM were selected from our prospective database: 318 consecutive POEMs performed from October 2009 to October 2016...
November 6, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29108981/outcomes-of-per-oral-endoscopic-myotomy-for-treatment-of-esophageal-achalasia-with-a-median-follow-up-of-49-months
#9
Quan-Lin Li, Qiu-Ning Wu, Xiao-Cen Zhang, Mei-Dong Xu, Wei Zhang, Shi-Yao Chen, Yun-Shi Zhong, Yi-Qun Zhang, Wei-Feng Chen, Wen-Zheng Qin, Jian-Wei Hu, Ming-Yan Cai, Li-Qing Yao, Ping-Hong Zhou
BACKGROUND AND AIMS: Per-oral endoscopic myotomy (POEM) has received wide acceptance as a highly effective and safe treatment for esophageal achalasia. Short-term and small-scale studies are ample but long-term large-scale studies are few. The aim of the study was to systematically analyze our long-term results of POEM, with particular emphasis on POEM failures and associated risk factors. METHODS: This is a single-center study. Consecutive POEM patients between August 2010 and December 2012 were included...
November 3, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29102729/gastroesophageal-reflux-disease-after-per-oral-endoscopic-myotomy-as-compared-with-heller-s-myotomy-with-fundoplication-a-systematic-review-with-meta-analysis
#10
REVIEW
Alessandro Repici, Lorenzo Fuccio, Roberta Maselli, Fabrizio Mazza, Loredana Correale, Daniele Mandolesi, Cristina Bellisario, Amrita Sethi, Mouen Kashab, Thomas Rösch, Cesare Hassan
BACKGROUND AND AIMS: Per-oral endoscopic myotomy (POEM) represents a less invasive alternative, as compared with conventional laparoscopic Heller's myotomy (LHM), for achalasia patients. It cannot be excluded, however, that the lack of fundoplication after POEM may result in a higher incidence of reflux disease, as compared with LHM. The aim was to conduct a systematic review of prospective studies reporting the incidence of reflux disease developed after POEM and LHM. METHODS: Literature search with electronic databases was performed (up to February 2017) to identify full articles on the incidence of gastro-esophageal reflux symptoms, endoscopic- and pH-monitoring-findings after POEM and LHM (with fundoplication)...
November 1, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29101956/anesthesia-for-routine-and-advanced-upper-gastrointestinal-endoscopic-procedures
#11
REVIEW
Christopher D Sharp, Ezekiel Tayler, Gregory G Ginsberg
This article aims to detail the breadth and depth of advanced upper gastrointestinal endoscopic procedures. It will focus on sedation and airway management concerns pertaining to this emerged and emerging class of minimally invasive interventions. The article will also cover endoscopic hemostasis, endoscopic resection, stenting and Barrett eradication therapy plus endoscopic ultrasound. It additionally will address the nuances of endoscopic retrograde cholangiopancreatography and new natural orifice transluminal endoscopic surgery procedures including endoscopic cystgastrostomy and the per-oral endoscopic myotomy procedure...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29089698/laparoscopic-heller-s-myotomy-for-achalasia-cardia-one-time-treatment-in-developing-countries
#12
Vishal Gupta, Hunaid Hatimi, Saket Kumar, Abhijit Chandra
Laparoscopic Heller's myotomy (LHM) and endoscopic balloon dilation are two main treatment modalities for achalasia cardia. The best treatment modality in Indian setting, however, is still unknown. Here, we present the early results of LHM in achalasia. Hospital data from January 2009 to October 2013 was analyzed. Preoperative assessment included Eckardt's scoring, esophagogastroduodenoscopy, barium swallow examination, and esophageal manometry. Thirty-five patients (19 males and 16 females, median age 31 years, range 12-65) underwent LHM with partial fundoplication (with intraoperative endoscopy)...
October 2017: Indian Journal of Surgery
https://www.readbyqxmd.com/read/29078682/the-current-state-of-per-oral-endoscopic-myotomy-for-achalasia
#13
REVIEW
Shane P Smith, Brian E Louie
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).
2017: Journal of visualized surgery
https://www.readbyqxmd.com/read/29016561/technical-advances-in-per-oral-endoscopic-myotomy-poem
#14
Chetan Mittal, Mihir S Wagh
No abstract text is available yet for this article.
November 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28989059/clinical-practice-update-the-use-of-per-oral-endoscopic-myotomy-in-achalasia-expert-review-and-best-practice-advice%C3%A2-from-the-aga-institute
#15
REVIEW
Peter J Kahrilas, David Katzka, Joel E Richter
The purpose of this review is to describe a place for per-oral endoscopic myotomy (POEM) among the currently available robust treatments for achalasia. The recommendations outlined in this review are based on expert opinion and on relevant publications from PubMed and EMbase. The Clinical Practice Updates Committee of the American Gastroenterological Association proposes the following recommendations: 1) in determining the need for achalasia therapy, patient-specific parameters (Chicago Classification subtype, comorbidities, early vs late disease, primary or secondary causes) should be considered along with published efficacy data; 2) given the complexity of this procedure, POEM should be performed by experienced physicians in high-volume centers because an estimated 20-40 procedures are needed to achieve competence; 3) if the expertise is available, POEM should be considered as primary therapy for type III achalasia; 4) if the expertise is available, POEM should be considered as treatment option comparable with laparoscopic Heller myotomy for any of the achalasia syndromes; and 5) post-POEM patients should be considered high risk to develop reflux esophagitis and advised of the management considerations (potential indefinite proton pump inhibitor therapy and/or surveillance endoscopy) of this before undergoing the procedure...
November 2017: Gastroenterology
https://www.readbyqxmd.com/read/28989004/per-oral-endoscopic-myotomy-in-achalasia-with-large-esophageal-diverticulum-the-owl-eyes-sign
#16
Zaheer Nabi, D Nageshwar Reddy, Mohan Ramchandani
No abstract text is available yet for this article.
October 5, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28987545/adverse-events-during-and-after-per-oral-endoscopic-myotomy-%C3%A2-prevention-diagnosis-and-management
#17
REVIEW
Zaheer Nabi, D Nageshwar Reddy, Mohan Ramchandani
Per-oral endoscopic myotomy (POEM) has surfaced as an effective endoscopic treatment modality for achalasia cardia (AC). Promising results in short- and mid-term follow-up studies have increased the use of POEM for the management of AC. POEM can be safely performed in an endoscopy suit, and major adverse events (AEs) are uncommon. AEs encountered during POEM or during the perioperative period principally include insufflation-related AEs, mucosal injuries, bleeding, pain, and aspiration pneumonia. Most insufflation-related AEs do not require an active intervention and therefore should not be considered as AEs in the true sense...
January 2018: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28984645/advances-in-the-endoscopic-management-of-gastric-outflow-disorders
#18
Andrew C Storm, Marvin Ryou
PURPOSE OF REVIEW: Disorders of gastric outflow and outlet obstruction include a variety of benign and malignant disorders such as peptic strictures, foreign bodies, gastroparesis, and cancers of the stomach, duodenum, and pancreas. Historically, a majority of patients presenting with gastric outlet obstruction (GOO) were to the result of peptic ulcers and surgical management of peptic ulcer complications was a mainstay of general surgical training. Invasive surgery is being performed less frequently today due to realization of the role of Helicobacter pylori in peptic ulcer disease and the introduction of novel endoscopic techniques for management of GOO...
November 2017: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/28966450/comparison-of-outcomes-of-laparoscopic-heller-myotomy-versus-per-oral-endoscopic-myotomy-for-management-of-achalasia
#19
Steven G Leeds, J S Burdick, Gerald O Ogola, Estrellita Ontiveros
Achalasia is a rare disorder that has several treatment options. The gold standard of treatment is a surgical myotomy called a laparoscopic Heller myotomy (LHM). More recently, an endoscopic myotomy has become an option as well, called per-oral endoscopic myotomy (POEM). An achalasia registry was queried for patients undergoing either LHM or POEM at Baylor University Medical Center at Dallas. Patient demographics, preoperative and postoperative data points, and Eckardt scores were collected. The patients were further stratified into their follow-up intervals, immediate postoperative and long-term follow-up, to assess surgical success...
October 2017: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/28951579/expert-consensus-document-advances-in-the-management-of-oesophageal-motility-disorders-in-the-era-of-high-resolution-manometry-a-focus-on-achalasia-syndromes
#20
REVIEW
Peter J Kahrilas, Albert J Bredenoord, Mark Fox, C Prakash Gyawali, Sabine Roman, André J P M Smout, John E Pandolfino
High-resolution manometry (HRM) and new analysis algorithms, summarized in the Chicago Classification, have led to a restructured classification of oesophageal motility disorders. This advance has led to increased detection of clinically relevant disorders, in particular achalasia. It has become apparent that the cardinal feature of achalasia - impaired lower oesophageal sphincter (LES) relaxation - can occur in several disease phenotypes: without peristalsis (type I), with pan-oesophageal pressurization (type II), with premature (spastic) distal oesophageal contractions (type III), or with preserved peristalsis (outlet obstruction)...
November 2017: Nature Reviews. Gastroenterology & Hepatology
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