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Per oral endoscopy myotomy

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https://www.readbyqxmd.com/read/29380066/outcomes-and-quality-of-life-assessment-after-per-oral-endoscopic-myotomy-poem-performed-in-the-endoscopy-unit-with-trainees
#1
Sunil Dacha, Lei Wang, Xaioyu Li, Yueping Jiang, George Philips, Steven A Keilin, Field F Willingham, Qiang Cai
BACKGROUND: Per oral endoscopic myotomy (POEM) has emerged as a promising option for the treatment of achalasia. This study assessed POEM training process, outcomes, and improvement in quality of life after POEM performed by an interventional endoscopist (mentor) with trainees. METHODS: We performed a retrospective review of data for patients who underwent POEM with involvement of trainees. Trainees were trained in performing mucosotomy, submucosal dissection, creating submucosal tunnel, identifying gastroesophageal junction, myotomy, and closure of mucosal incision in a step-by-step fashion...
January 29, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29353638/submucosal-surgery-novel-interventions-in-the-third-space
#2
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/29228523/advanced-therapeutic-gastrointestinal-endoscopy-in-children-today-and-tomorrow
#3
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/29089698/laparoscopic-heller-s-myotomy-for-achalasia-cardia-one-time-treatment-in-developing-countries
#4
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/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
#5
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/28840505/anesthesia-in-per-oral-endoscopic-myotomy-a-large-tertiary-care-centre-experience
#6
Santosh Darisetty, Zaheer Nabi, Mohan Ramchandani, Radhika Chavan, Rama Kotla, D Nageshwar Reddy
BACKGROUND AND OBJECTIVES: Per-oral endoscopic myotomy (POEM) is safe and efficacious for the management of achalasia cardia (AC). POEM is usually performed under general anesthesia in an endoscopy suite or operating theatre. The current study was conducted with the aim to analyse anesthetic management of patients with AC who underwent POEM at our institution. METHODS: We retrospectively analysed the data of patients with AC who underwent POEM at our institution from January 2013 to September 2016...
July 2017: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
https://www.readbyqxmd.com/read/28839899/poem-and-the-management-of-achalasia
#7
Matthew Banks, Rami Sweis
Achalasia is a rare oesophageal motility disorder predominantly causing dysphagia and regurgitation of food and fluids. Diagnosis is made typically after a combination of tests including endoscopy, barium swallow and oesophageal manometry. The advent of high-resolution manometry has led to the Chicago Classification which divided achalasia into three types. This improved the understanding of presentation, prognosis and might also help tailor therapy. Botulinum toxin has been shown to have good, but short-term efficacy...
April 2017: Frontline Gastroenterology
https://www.readbyqxmd.com/read/28832360/gastric-interventional-endoscopy
#8
Mohamed Mahmoud, Erik Holzwanger, Wahid Wassef
PURPOSE OF REVIEW: To review new advances in gastric interventional endoscopy. RECENT FINDINGS: Implementation of gastric endoscopy as a therapeutic option in obesity, gastric cancer, and gastroparesis. SUMMARY: Less invasive new gastric endoscopic procedures can potentially replace currently offered laparoscopic approaches in many fields. In this article, we will review the use of endoscopic sleeve gastroplasty as a weight loss procedure, endoscopic submucosal dissection in treatment of early gastric cancer, and gastric per-oral endoscopic myotomy in treatment of refractory gastroparesis...
November 2017: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/28660419/per-oral-endoscopic-myotomy-vs-laparoscopic-heller-myotomy-does-gastric-extension-length-matter
#9
Mauricio Ramirez, Cecilia Zubieta, Franco Ciotola, Alfredo Amenabar, Adolfo Badaloni, Fabio Nachman, Alejandro Nieponice
OBJECTIVE: To report our experience in POEM vs. LHM, with particular focus on myotomy extension. BACKGROUND: POEM has been adopted worldwide as a treatment for achalasia. While resolution of dysphagia is above 90%, postoperative reflux ranges from 10 to 57%. Myotomy length has been a controversial topic. METHODS: Thirty-five cases of POEM were prospectively analyzed and compared retrospectively to the last 35 patients that underwent LHM, from December 2010 to August 2016...
June 28, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28574971/per-oral-endoscopic-myotomy-in-children-first-experience-with-a-new-triangular-knife
#10
Zaheer Nabi, Mohan Ramchandani, Radhika Chavan, Manu Tandan, Rakesh Kalapala, Santosh Darisetty, D Nageshwar Reddy
OBJECTIVES: Per-oral endoscopic myotomy (POEM) is a novel treatment modality for achalasia cardia (AC). The procedure is technically challenging and time consuming. Recently, a new triangle knife (TTJ) has been introduced which is equipped with water jet facility. In this study, we analysed the feasibility, safety and efficacy of POEM in children with new triangle tip knife. METHODS: We retrospectively evaluated the data of children (≤18 years) who underwent POEM using TTJ knife at our institution...
June 2, 2017: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/28573173/ex-vivo-experimental-study-on-the-thulium-laser-system-new-horizons-for-interventional-endoscopy-with-videos
#11
Gian Eugenio Tontini, Helmut Neumann, Alessandro Rimondi, Sara Vavassori, Barbara Bruni, Gregorio Cattignoli, Ping-Hong Zhou, Luca Pastorelli, Maurizio Vecchi
BACKGROUND AND STUDY AIMS:  The Thulium laser system (TLS) is an emerging interventional tool adopted in many surgical specialties. Its 2.0-μm wavelength allows precise coagulation (0.2 - 0.4 mm in depth) and cutting, limiting the possibilities of collateral injuries. We tested the impact of the TLS for gastric endoscopic submucosal dissection (ESD) and per oral endoscopic myotomy (POEM) ex vivo in pigs. MATERIALS AND METHODS:   Ex vivo porcine stomach and esophagus models underwent 2 POEMs, and 3 ESDs (mean diameter 3...
June 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/28393437/what-is-the-clinical-significance-of-esophagogastric-junction-outflow-obstruction-evaluation-of-60-patients-at-a-tertiary-referral-center
#12
F C Okeke, S Raja, K L Lynch, S Dhalla, M Nandwani, E M Stein, B Chander Roland, M A Khashab, P Saxena, V Kumbhari, N K Ahuja, J O Clarke
BACKGROUND: Esophagogastric junction (EGJ) outflow obstruction (EGJOO) is characterized by impaired EGJ relaxation with intact or weak peristalsis. Our aims were to evaluate: (i) prevalence, (ii) yield of fluoroscopy, endoscopy, and endoscopic ultrasound (EUS), (iii) outcomes, and (iv) whether this data differed based on quantitative EGJ relaxation. METHODS: Studies that met criteria for EGJOO were identified. Demographics, encounters, endoscopy, radiology, treatment decisions, and outcomes were extracted...
June 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/28235595/an-international-multicenter-study-evaluating-the-clinical%C3%A2-efficacy-and-safety-of-per-oral-endoscopic-myotomy%C3%A2-in%C3%A2-octogenarians
#13
Yen-I Chen, Haruhiro Inoue, Michael Ujiki, Peter V Draganov, Paul Colavita, Francois Mion, John Romanelli, Philip Chiu, Valerio Balassone, Lava Patel, Ali Abbas, Dennis Yang, Christy Dunst, Mathieu Pioche, Sabine Roman, Jérôme Rivory, Thierry Ponchon, David Desilets, Roberta Maselli, Manabu Onimaru, Jun Nakamura, Yoshitaka Hata, Gulara Hajiyeva, Amr Ismail, Saowanee Ngamruengphong, Majidah Bukhari, Yamile Haito Chavez, Vivek Kumbhari, Alessandro Repici, Mouen A Khashab
BACKGROUND AND AIMS: Per-oral endoscopic myotomy (POEM) for achalasia is particularly appealing in the elderly because it is minimally invasive. However, data in patients aged ≥80 years are scarce. The aim of this study was to assess the clinical outcome of POEM in octogenarians. METHODS: This was a multicenter retrospective study at 8 centers. Consecutive octogenarians with achalasia who underwent POEM between 2010 and 2016 were included. Rates of technical success (completion of myotomy), clinical response (Eckardt score ≤3), and adverse events (severity graded as per American Society for Gastrointestinal Endoscopy lexicon) were assessed...
February 21, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28161449/outcomes-and-quality-of-life-assessment-after-gastric-per-oral-endoscopic-pyloromyotomy-with-video
#14
Sunil Dacha, Parit Mekaroonkamol, Lianyong Li, Nikrad Shahnavaz, Sonali Sakaria, Steven Keilin, Field Willingham, Jennifer Christie, Qiang Cai
BACKGROUND AND AIM: Gastric per-oral endoscopic pyloromyotomy (GPOEM) is emerging as a promising option for the treatment of gastroparesis. This study assessed outcomes and quality of life after GPOEM for gastroparesis, performed in an endoscopy unit at a major tertiary referral center. METHODS: We performed a retrospective review of patients who had undergone GPOEM from June 2015 to July 2016. Data were collected from electronic medical records and included patient demographics, endoscopy records, hospitalization records, clinic visits, and electronic messages...
August 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/27909548/microvasculature-of-the-esophagus-and-gastroesophageal-junction-lesson-learned-from-submucosal-endoscopy
#15
REVIEW
Roberta Maselli, Haruhiro Inoue, Haruo Ikeda, Manabu Onimaru, Akira Yoshida, Esperanza Grace Santi, Hiroki Sato, Bu'Hussain Hayee, Shin-Ei Kudo
Advanced therapeutic endoscopy, in particular endoscopic mucosal resection, endoscopic submucosal dissection, per-oral endoscopic myotomy, submucosal endoscopic tumor resection opened a new era where direct esophageal visualization is possible. Combining these information with advanced diagnostic endoscopy, the esophagus is organized, from the luminal side to outside, into five layers (epithelium, lamina propria with lamina muscularis mucosa, submucosa, muscle layer, adventitia). A specific vascular system belonging to each layer is thus visible: Mucosa with the intra papillary capillary loop in the epithelium and the sub-epithelial capillary network in the lamina propria and, at the lower esophageal sphincter (LES) level with the palisade vessels; submucosa with the drainage vessels and the spindle veins at LES level; muscle layer with the perforating vessels; peri-esophageal veins in adventitia...
November 16, 2016: World Journal of Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/27868244/ddw-2016-review-advances-in-therapeutic-upper-gastrointestinal-endoscopy
#16
REVIEW
Shannon Melissa Chan, Baldwin Yeung, Philip Wai Yan Chiu
This is a review of the abstracts presented at Digestive Disease Week 2016, 21-24 May 2016 in San Diego, CA, USA, focusing on novel advances in therapeutic endoscopy of the upper gastrointestinal tract.
March 2017: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
https://www.readbyqxmd.com/read/27609778/early-adverse-events-of-per-oral-endoscopic-myotomy
#17
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 AND 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 (AEs). METHODS: POEM was performed on 241 patients (58% male; mean age, 47.4 ± 16.4 years) under general anesthesia over 61 months. The main outcome was the rate of intra- and post-procedural AEs. Post-procedural checks comprised clinical and laboratory examinations and endoscopy, with further follow-ups performed at 3, 6, and 12 months...
April 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/27568151/the-state-of-the-art-in-per-oral-endoscopic-myotomy
#18
REVIEW
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
https://www.readbyqxmd.com/read/27440038/-minimally-invasive-treatment-of-esophageal-benign-diseases
#19
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
https://www.readbyqxmd.com/read/26839644/endoscopic-treatment-of-esophageal-achalasia
#20
Dario Esposito, Francesco Maione, Alessandra D'Alessandro, Giovanni Sarnelli, Giovanni D De Palma
Achalasia is a motility disorder of the esophagus characterized by dysphagia, regurgitation of undigested food, chest pain, weight loss and respiratory symptoms. The most common form of achalasia is the idiopathic one. Diagnosis largely relies upon endoscopy, barium swallow study, and high resolution esophageal manometry (HRM). Barium swallow and manometry after treatment are also good predictors of success of treatment as it is the residue symptomatology. Short term improvement in the symptomatology of achalasia can be achieved with medical therapy with calcium channel blockers or endoscopic botulin toxin injection...
January 25, 2016: World Journal of Gastrointestinal Endoscopy
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