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Per oral endoscopic myotomy

Saowanee Ngamruengphong, Haruhiro Inoue, Philip Chiu, Hon-Chi Yip, Amol Bapaye, Michael Ujiki, Lava Patel, Pankaj N Desai, Bu Hayee, Amyn Haji, Vivien Wong, Silvana Perretta, Shivangi Dorwat, Mathieu Pioche, Sabine Roman, Jérôme Rivory, François Mion, Thierry Ponchon, Aurélien Garros, Jun Nakamura, Yoshitaka Hata, Valerio Balassone, Manabu Onimaru, Gulara Hajiyeva, Amr Ismail, Yen-I Chen, Majidah Bukhari, Yamile Haito-Chavez, Vivek Kumbhari, Roberta Maselli, Alessandro Repici, Mouen A Khashab
BACKGROUND: Per-oral endoscopic myotomy (POEM) has shown promising safety and efficacy in short-term studies. However, long term follow-up data is very limited. The aims of this study were to assess (1) clinical outcome of patients with a minimum post-POEM follow-up of 2 years and (2) factors associated with long term clinical failure after POEM. METHODS: A retrospective chart review was performed that included all consecutive patients with achalasia who underwent POEM with a minimum follow-up of 2 years at 10 tertiary-care centers...
September 20, 2016: Gastrointestinal Endoscopy
Yuki B Werner, Daniel von Renteln, Tania Noder, Guido Schachschal, Ulrike W Denzer, Stefan Groth, Jan F Nast, Jan F Kersten, Martin Petzoldt, Gerhard Adam, Oliver Mann, Alessandro Repici, Cesare Hassan, Thomas Rösch
BACKGROUND & AIMS: The recently developed technique of per-oral endoscopic myotomy (POEM) has been shown to be effective for the therapy of esophageal motility disorders. Limited information is available about POEM adverse events (AE). METHODS: POEM was performed with the patients under general anesthesia in 241 patients (58% male, mean age 47.4 ± 16.4 years) during 61 months. Main outcome was the rate of intra- and post-procedural adverse events (AE). Post-procedural checks comprised clinical and laboratory examination, and endoscopy, with further follow-ups being performed at 3, 6 and 12 months, respectively...
September 5, 2016: Gastrointestinal Endoscopy
Michael F Vaezi, Valter N Felix, Roberto Penagini, Aurelio Mauro, Eduardo Guimarães Hourneaux de Moura, Leonardo Zorrón Cheng Tao Pu, Jan Martinek, Erwin Rieder
Achalasia is an esophageal motility disorder associated with abnormalities in peristalsis and lower esophageal sphincter (LES) relaxation. The etiology of the disease remains elusive. It is often misdiagnosed initially as gastroesophageal reflux disease. Patients with achalasia often complain of dysphagia to solids and liquids but may focus on regurgitation as the primary symptom, leading to the early misdiagnosis. Chest pain, weight loss, and occasional vomiting may be additional symptoms encountered in those with achalasia...
August 29, 2016: Annals of the New York Academy of Sciences
Stavros N Stavropoulos, Rani Modayil, David Friedel
Per-oral endoscopic myotomy has emerged as the preferred option for treatment of achalasia. This entirely endoscopic procedure has clinical efficacy and lower esophageal sphincter disruption comparable to laparoscopic Heller myotomy with lesser postprocedure pain and length of stay. This review describes per-oral endoscopic myotomy technique, evolution, patient selection, comparison to other therapies, training, and future considerations, including extrapolation of tunnel endoscopy to other situations.
2016: Seminars in Thoracic and Cardiovascular Surgery
Brian E Louie, Andreas M Schneider, Drew B Schembre, Ralph W Aye
BACKGROUND: Per oral endoscopic myotomy (POEM) is performed by accessing the submucosal space of the esophagus. This space may be impacted by prior interventions such as submucosal injections, dilations or previous myotomies. These interventions could make POEM more difficult and may deter surgeons during their initial experience. We sought to determine the impact of prior interventions on our early experience. METHODS: Prospective, single-center study of consecutive patients undergoing POEM...
August 23, 2016: Surgical Endoscopy
Heidi J Miller, Ruel Neupane, Mojtaba Fayezizadeh, Arnab Majumder, Jeffrey M Marks
BACKGROUND: Achalasia is a rare motility disorder of the esophagus. Treatment is palliative with the goal of symptom remission and slowing the progression of the disease. Treatment options include per oral endoscopic myotomy (POEM), laparoscopic Heller myotomy (LM) and endoscopic treatments such as pneumatic dilation (PD) and botulinum toxin type A injections (BI). We evaluate the economics and cost-effectiveness of treating achalasia. METHODS: We performed cost analysis for POEM, LM, PD and BI at our institution from 2011 to 2015...
August 17, 2016: Surgical Endoscopy
Andreas M Schneider, Brian E Louie, Heather F Warren, Alexander S Farivar, Drew B Schembre, Ralph W Aye
BACKGROUND: Per oral endoscopic myotomy (POEM) is increasingly utilized to treat patients with achalasia. Early results have demonstrated significant improvement of symptoms, but there are concerns about postoperative reflux. With only limited comparative data available, we sought to compare POEM to laparoscopic Heller myotomy (LHM) with partial fundoplication. METHODS: This is a retrospective review of 42 POEM and 84 LHM patients undergoing primary myotomy for achalasia...
August 11, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Eric S Hungness, Joel M Sternbach, Ezra N Teitelbaum, Peter J Kahrilas, John E Pandolfino, Nathaniel J Soper
OBJECTIVE: We aimed to report long-term outcomes for patients undergoing per-oral endoscopic myotomy (POEM) after our initial 15-case learning curve. BACKGROUND: POEM has become an established, natural-orifice surgical approach for treating esophageal motility disorders. To date, published outcomes and comparative-effectiveness studies have included patients from the early POEM experience. METHODS: Consecutive patients undergoing POEM after our initial 15 cases, with a minimum of 1-year postoperative follow-up, were included...
September 2016: Annals of Surgery
Jean-Michel Gonzalez, Valentin Lestelle, Alban Benezech, Jonah Cohen, Véronique Vitton, Jean-Charles Grimaud, Marc Barthet
BACKGROUND AND AIMS: Gastroparesis is a chronic, debilitating condition. We report an experience conducting G-POEM with objectives to assess clinical efficacy, gastric emptying evolution and procedural adverse events. MATERIAL AND METHODS: Clinical pilot series on 12 consecutive patients who underwent G-POEM for refractory gastroparesis in our tertiary center between February 2014 and August 2015 Patients included had severe disease as defined by elevated GCSI score and delayed gastric emptying scintigraphy (GES)...
July 28, 2016: Gastrointestinal Endoscopy
Yamile Haito Chavez, Saowanee Ngamruengphong, Majidah Bukhari, Yen-I Chen, Gerard Aguila, Mouen A Khashab
No abstract text is available yet for this article.
July 23, 2016: Gastrointestinal Endoscopy
Haruhiro Inoue
As a minimally invasive treatment of esophageal achalasia per-oral endoscopic myotomy( POEM) was developed in 2008. More than 1,100 cases of achalasia-related diseases received POEM. Success rate of the procedure was more than 95%(Eckerdt score improvement 3 points and more). No serious( Clavian-Dindo classification III b and more) complication was experienced. These results suggest that POEM becomes a standard minimally invasive treatment for achalasia-related diseases. As an off-shoot of POEM submucosal tumor removal through submucosal tunnel (per-oral endoscopic tumor resection:POET) was developed and safely performed...
July 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Rodolfo J Oviedo, Chase W Sofiak, Bruce M Dixon
INTRODUCTION: Achalasia is a condition that occurs when the lower esophageal sphincter (LES) fails to properly relax, combined with slowing/failure of esophageal peristalsis. This is seen clinically by not allowing solids and liquids to pass easily into the stomach. Achalasia is not historically associated with morbid obesity, yet dual treatment of morbid obesity and achalasia is becoming more prominent due to the worldwide obesity epidemic. PRESENTATION OF CASE: Achalasia is typically a disease that affects non-obese adults over the age of 55, which makes the discussion of this case report unique in that our patient is a 23 year-old woman who successfully underwent per-oral endoscopic myotomy (POEM) in preparation for a future laparoscopic sleeve gastrectomy...
2016: International Journal of Surgery Case Reports
Salvatore Docimo, Abraham Mathew, Alexander J Shope, Joshua S Winder, Randy S Haluck, Eric M Pauli
INTRODUCTION: Per-oral endoscopic myotomy (POEM) is a less invasive therapy for achalasia with a shorter hospitalization but with similar short- and long-term outcomes as a laparoscopic Heller myotomy (LHM). Previous literature comparing POEM to LHM has focused primarily on postoperative outcome parameters such as complications, dysphagia scores and gastro-esophageal reflux severity. This study specifically compares postoperative pain following POEM to pain following LHM, the current gold-standard operation...
June 23, 2016: Surgical Endoscopy
Brian Williams, Jonathan Kass, Rishi Maheshwary, Krishna Gurram, Matthew Hartman
Achalasia is a debilitating condition resulting from the failure of appropriate lower esophageal sphincter relaxation. Traditionally, the treatment of choice for achalasia has been a Heller myotomy, performed either via laparotomy or laparoscopically. The latter method has gained wide popularity in its documented lower postoperative morbidity. Recently, however, a new technique has been developed that can be performed by both thoracic surgeons and endoscopists-Per-Oral Endoscopic Myotomy. This procedure offers an alternative to invasive surgery and provides excellent outcomes with minimal recovery time...
April 4, 2016: Current Problems in Diagnostic Radiology
Ningli Chai, Enqiang Linghu, Xiaobin Zhang, Guopeng Yao, Xiaotong Niu
No abstract text is available yet for this article.
May 23, 2016: Gastrointestinal Endoscopy
Eduardo Couchonnal, Jérôme Rivory, Sabine Roman, Thierry Ponchon, Mathieu Pioche
No abstract text is available yet for this article.
May 10, 2016: Gastrointestinal Endoscopy
Kevin L Grimes, Haruhiro Inoue
Historically, the most robust outcomes in treatment of achalasia were seen with surgical myotomy. Per oral endoscopic myotomy (POEM) introduced an endoscopic method for creating a surgical myotomy. Thousands of cases of POEM have been performed; however, there is no standard technique, and the rates of clinical success and adverse events vary widely among centers. This article presents a detailed description of the POEM technique, including the rationale and potential pitfalls of the main variations, in the context of the international literature...
May 2016: Thoracic Surgery Clinics
Amol Bapaye, Mahesh Mahadik, Rajendra Pujari, Viral Vyas, Nachiket Dubale
No abstract text is available yet for this article.
October 2016: Gastrointestinal Endoscopy
Nishmi Gunasingam, Adam Perczuk, Michael Talbot, Arthur Kaffes, Payal Saxena
Achalasia is a primary esophageal motility disorder. It is the absence of peristalsis in the esophageal body and inability of the lower esophageal sphincter to relax, which characterizes this rare condition. Its features typically include dysphagia, regurgitation, chest pain, and weight loss. The ultimate goal in treating achalasia is to relieve the patient's symptoms, improve esophageal emptying, and prevent further dilatation of the esophagus. Current treatment modalities targeted at achalasia include pharmacological therapy, endoscopic therapy, and surgery...
August 2016: Journal of Gastroenterology and Hepatology
Amit P Desai, Amy Tyberg, Prashant Kedia, Michael S Smith, Guadalupe Martinez, Felipe Zamarripa, Yecheskel Schneider, Helga Bertani, Marzio Frazzoni, Fernando Casas, Lauren G Khanna, Arnon Lambroza, Nikhil A Kumta, Ali Khan, Reem Z Sharaiha, Sanjay Salgado, Monica Gaidhane, Amrita Sethi, Michel Kahaleh
BACKGROUND: Per-oral endoscopic myotomy (POEM) has emerged as an endoscopic treatment of achalasia. There are no pre-procedural imaging modalities to predict the safest and the most efficacious approach. AIM: To evaluate the use of optimal coherence tomography (OCT) in providing a pre-procedural esophageal assessment. METHODS: Patients undergoing POEM from July 2013 to November 2015 were captured in a multicenter, international registry. Patients who underwent OCT pre-POEM ("OCT arm") were compared to patients without pre-POEM OCT ("control arm")...
April 8, 2016: Surgical Endoscopy
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