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Peroral endoscopic myotomy

Jan Friso Nast, Christoph Berliner, Thomas Rösch, Daniel von Renteln, Tania Noder, Guido Schachschal, Stefan Groth, Harald Ittrich, Jan F Kersten, Gerhard Adam, Yuki B Werner
BACKGROUND: The newly developed technique of peroral endoscopic myotomy (POEM) has been shown to be effective in several short- and mid-term studies. Limited information is available about the adequacy of immediate post-POEM monitoring tests. METHODS: POEM was performed under general anesthesia in 228 patients (59.6% male, mean age 45.6 ± 15.5 years). Post-procedural checks comprised clinical and laboratory examination, and, during post-procedure days 1-5, endoscopy and-in the first 114 cases-radiologic examination using water-soluble contrast (1st group); the remaining patients underwent post-procedure controls without radiology (2nd group)...
March 15, 2018: Surgical Endoscopy
W Schröder, C J Bruns
No abstract text is available yet for this article.
March 8, 2018: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
Anca Dimitriu, Cristian Gheorghe
High resolution manometry (HRM) is currently the gold standard for the diagnosis of achalasia and other functional esophageal disorders. All patients accusing dysphagia should be endoscopically evaluated prior to manometric investigations in order to rule out pseudoachalasia. The Chicago HRM classification has led to a subclassification of three manometric types of achalasia that seem to have different results to treatment. None of the actual achalasia treatment options are curative. Type II achalasia patients respond best to all treatment options compared to those with types I and III...
January 2018: Chirurgia
O V Hernández-Mondragón, O M Solórzano-Pineda, M A González-Martínez, J M Blancas-Valencia, C Caballero-Luengas
INTRODUCTION AND AIMS: Achalasia is characterized by the absence of lower esophageal sphincter relaxation and esophageal aperistalsis. Diagnosis is confirmed through high-resolution esophageal manometry. Laparoscopic myotomy is the standard treatment, but peroral endoscopic myotomy (POEM) is a safe and effective alternative, with good short-term and medium-term results. Our aim was to describe the short-term and medium-term experience with POEM at a tertiary care center. MATERIALS AND METHODS: The study was conducted within the time frame of November 2014 and February 2017...
February 26, 2018: Revista de Gastroenterología de México
Samiullah Khan, Shuai Su, Kui Jiang, Bang-Mao Wang
RATIONALE: Retrograde gastroesophageal intussusception (RGEI) is a relatively rare gastrointestinal (GI) disorder in which a portion of the stomach wall invaginates into the esophagus. More recently, peroral endoscopic myotomy (POEM) has emerged as an endoscopic alternative to surgical myotomy for achalasia, and, to the best of our knowledge, our case is the first RGEI after POEM to be reported. PATIENT CONCERNS: A 22-year-old male was presented with a history of vomiting, intractable retching and hematemesis for 3 days...
January 2018: Medicine (Baltimore)
Mouen A Khashab, Petros C Benias, Lee L Swanstrom
Peroral endoscopic myotomy (POEM) is an advanced endoscopic procedure classically performed for the treatment of achalasia. The procedure is based on principles of submucosal endoscopy and is comprised of a mucosal incision, submucosal tunneling, myotomy and mucosal closure. Multiple published studies that collectively include more than 6000 patients reported clinical success in more than 80-90% of patients. Recent literature also suggested durability of response over a medium-term follow-up. POEM is associated with a low rate of adverse events when performed by experienced operators...
February 15, 2018: Gastroenterology
Kevin A Waschke, Walter Coyle
One of the challenges of the current era is ensuring that endoscopic training is accomplished effectively in the face of multiple competing demands. As healthcare delivery evolves, with rising patient complexity and increasing productivity requirements, there is mounting pressure on the time available for training in the clinical setting. The practice of endoscopy itself continues to expand to include increasingly complex procedures (e.g. therapeutic endoscopic ultrasound (EUS), endoscopic submucosal dissection (ESD), peroral endoscopic myotomy (POEM), etc...
February 15, 2018: Gastroenterology
Antonio Carlos Coelho Conrado, Joao Guilherme Guerra, Claudio Lyoiti Hashimoto, Marcelo Averbach, Miguel Arcanjo Dos Santos, Peter Vassilev Draganov
No abstract text is available yet for this article.
February 16, 2018: Endoscopy
Zaheer Nabi, Mohan Ramchandani, Radhika Chavan, Rakesh Kalapala, Santosh Darisetty, D Nageshwar Reddy
Background and Aim: Peroral endoscopic myotomy (POEM) is a technically demanding procedure. Recently, a new triangular knife with integrated water jet function (TTJ) has been introduced. The present study was aimed to analyze and compare the operating time, efficacy, and adverse events (AEs) between the conventional (TT knife) and new knife (TTJ). Patients and Methods: All patients with achalasia cardia (AC) who underwent POEM between August 2015 and November 2016 were analyzed retrospectively...
January 2018: Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association
Mouen A Khashab
No abstract text is available yet for this article.
January 2018: Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association
Marinde van Lennep, Michiel P van Wijk, Taher I M Omari, Marc A Benninga, Maartje M J Singendonk
Achalasia is a rare esophageal motility disorder. Much of the literature is based on the adult population. In adults, guidance of therapeutic approach by manometric findings has led to improvement in patient outcome. Promising results have been achieved with novel therapies such as PerOral Endoscopic Myotomy (POEM). Areas covered: In this review, we provide an overview of the novel diagnostic and therapeutic tools for achalasia management and in what way they will relate to the future management of pediatric achalasia...
April 2018: Expert Review of Gastroenterology & Hepatology
Dennis Yang, Peter V Draganov
OPINION STATEMENT: "Third space" endoscopy, also commonly referred as submucosal endoscopy, is founded on the principle that the deeper layers of the gastrointestinal (GI) tract can be accessed by tunneling in the submucosal space without compromising the integrity of the overlying mucosa. Peroral endoscopic myotomy (POEM), endoscopic submucosal dissection (ESD), and submucosal tunneling endoscopic resection (STER) are innovative techniques within the field of third space endoscopy in the management of esophageal disorders...
March 2018: Current Treatment Options in Gastroenterology
Mohan Ramchandani, Zaheer Nabi, D Nageshwar Reddy, Rahul Talele, Santosh Darisetty, Rama Kotla, Radhika Chavan, Manu Tandan
Background and study aims:  Peroral endoscopic myotomy (POEM) can be performed via an anterior or posterior approach, depending on the operator's preference. Data are lacking on comparative outcomes of both approaches. Patients and methods:  This is a pilot randomized study comparing endoscopic anterior and posterior myotomy during POEM in patients with Achalasia cardia (AC). Patients were randomized into 2 groups (n = 30 in each group); anterior myotomy group (AG) and posterior myotomy group (PG) and were followed at 1, 3 and 6 months after POEM...
February 2018: Endoscopy International Open
Young Kwan Cho, Seong Hwan Kim
Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus...
January 2018: Clinical Endoscopy
Hyunsoo Chung, Mouen A Khashab
Gastroparesis (GP) is a syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach or proximal small bowel. Currently available dietary and medical therapies are limited and have suboptimal efficacy. Pylorus-directed therapies have showed promising results. Gastric peroral endoscopic myotomy (G-POEM) has been reported for the treatment of GP refractory to standard therapy with promising results. This article reviews the current applications and results of G-POEM for the treatment of refractory GP...
January 2018: Clinical Endoscopy
Steven P Bowers, Timothy Woodward
Although there has been debate regarding the optimal procedure to palliate dysphagia in patients with achalasia, emerging reports of longer term follow-up of patients after peroral endoscopic myotomy (POEM) suggest that the POEM procedure is efficacious in relief of dysphagia, and that there is infrequent need for subsequent procedures for treatment of failure or reflux. The number of centers in the United States of America performing POEM for esophageal achalasia continues to increase. This report assess the current knowledge of technical issues of POEM, outcomes after POEM and the status of POEM centers in the U...
January 23, 2018: Minerva Chirurgica
Weon Jin Ko, Joo Young Cho
The concept of using natural orifices to reduce the complications of surgery, Natural Orifices Transluminal Endoscopic Surgery, has also been applied to therapeutic endoscopy. Endoscopic submucosal surgery (ESS) provides more treatment options for various gastrointestinal diseases than traditional therapeutic endoscopy by using the submucosal layer as a working space. ESS has been performed in various fields ranging from transluminal peritoneoscopy to peroral endoscopic myotomy. With further advances in technology, ESS will be increasingly useful for diagnosis and treatment of gastrointestinal diseases...
January 23, 2018: Clinical Endoscopy
Nasim Parsa, Mouen A Khashab
OPINION STATEMENT: PURPOSE OF THE REVIEW: Peroral endoscopic myotomy (POEM) is a novel minimally invasive technique that has emerged as the preferred option for the treatment of achalasia and spastic esophageal disorders (SED) at many centers around the world. In this article, we review and summarize the recent literature on POEM in patients with achalasia and SED. The current article is largely focused on the new developments and findings, extended applications, and long-term outcomes of POEM in patients with achalasia and SED...
January 19, 2018: Current Treatment Options in Gastroenterology
Shinwa Tanaka, Fumiaki Kawara, Takashi Toyonaga, Robert Bechara, Namiko Hoshi, Hirofumi Abe, Yoshiko Ohara, Tsukasa Ishida, Yoshinori Morita, Eiji Umegaki
Background and study aims : In order to perform peroral endoscopic myotomy (POEM) safely, retained liquid and food debris must be removed before the procedure is started. We developed a novel technique using a super-slim gastroscope, and a gastric tube to remove retained food debris in achalasia patients. In this study, the safety and efficacy of this novel technique were investigated. Patients and methods : Eleven patients with achalasia were enrolled in this study and underwent this novel method for esophageal clearance...
January 2018: Endoscopy International Open
J Liu, Y Jiao, Y Niu, L Yu, M Ji, S Zhang
Esophageal achalasia is a type of motility disorder characterized by incomplete relaxation of lower esophageal sphincter (LES) and absence of esophageal peristalsis. Peroral endoscopic myotomy (POEM) is a new treatment option for achalasia that is less invasive, more effective, and safe as compared to surgery. High-frequency electrotome is commonly used in POEM, but takes longer time to make the tunnel in the esophagus and causes many complications. The thulium laser decreases the risk of bleeding and perforation in endoscopy but has not been reported in digestive diseases, especially in POEM...
January 9, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
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