A prospective analysis of GERD after POEM on anterior myotomy

Shiwaku, Hironari; Inoue, Haruhiro; Sasaki, Takuma; Yamashita, Kanefumi; Ohmiya, Toshihiro; Takeno, Shinsuke; Nimura, Satoshi; Yamashita, Yuichi

doi:10.1007/s00464-015-4507-0

Cited by 58 publications

(34 citation statements)

References 33 publications

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“…GERD-related symptoms appear in a small number of patients (8.2 [15] to 16.8% [30]) and the GERD-Questionnaire score decreases globally in the quality of life (QoL) series (31). However, up to 60% of patients present some grade of esophagitis in the upper endoscopy six months after the POEM procedure (32). Abnormal pH testing is present in 16 to 68.4% in the different series (21).…”

Section: Gerd After Poemmentioning

confidence: 99%

Efficacy of peroral endoscopic myotomy compared with other invasive treatment options for the different esophageal motor disorders

et al. 2017

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Short-term outcomes are similar to laparoscopic Heller myotomy (LHM) and pneumatic endoscopic dilation (PD) (clinical success > 90%) for achalasia subtypes I and II. Mid-term outcomes are comparable to LHM and overcome the results obtained after PD (> 90% vs ~50%). With regard to type III achalasia, POEM efficacy is 98% compared to 80.8% for LHM and the PD success remains at 40%. With regard to spastic esophageal disorders (SED), POEM has an effectiveness of 88% and 70% for distal esophageal spasm (DES) and jackhammer esophagus (JE) respectively. A response of 95% in patients with sigmoid esophagus has been reported. POEM has been performed in pediatric and elderly populations and has obtained a higher efficacy than PD in pediatric series (100% vs 33%) without greater adverse events. Previous treatments do not seem to hinder POEM results with excellent response rates, including 97% in post LHM and 100% in a re-POEM series. Final considerations: POEM has shown excellent short and mid-term results for all subtypes of achalasia but long-term results are not yet available. The promising results in SED may make POEM the first-line treatment for SED. A high-safety profile and efficacy have been shown in elderly and pediatric populations. Previous treatments do not seem to diminish the success rate of POEM. Core tip: POEM has emerged as an efficient treatment option for all subtypes of achalasia and other scenarios (including previous treatments and elderly and pediatric populations). Short and mid-term results are comparable to LHM and are better than PD data. The clinical response rate of DES and JE may make POEM the first-line treatment for SED.

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Section: Gerd After Poemmentioning

confidence: 99%

Efficacy of peroral endoscopic myotomy compared with other invasive treatment options for the different esophageal motor disorders

et al. 2017

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“…At present, POEM appears to be an effective treatment for achalasia, EGJOO, DES, and JE. However, it may cause irreversible fibrotic change in the esophageal muscle layer, particularly in the LES [76], and could induce post-POEM gastroesophageal reflux disease [77,78]. Further study is needed to elucidate the pathology and etiology of these complicated esophageal motility disorders, and allow for the development of a curative treatment.…”

Section: Resultsmentioning

confidence: 99%

Esophageal motility disorders: new perspectives from high-resolution manometry and histopathology

et al. 2017

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High-resolution manometry (HRM) and peroral endoscopic myotomy (POEM) have contributed significantly to the field of esophageal motility disorders in recent years. The development of HRM has categorized various esophageal motility disorders with a focus on a diverse range of manometric anomalies. Additionally, the Chicago classification criteria is widely used for manometric diagnosis. Moreover, POEM was introduced as a minimally invasive radical therapy for achalasia and shows promise for other spastic esophageal motility disorders as well. POEM has also enabled a transluminal endoscopic approach for determining the histology of the esophageal muscle layer, which is expected to assist in elucidating the etiology of disorders associated with esophageal motility. The purpose of this review is to update the diagnosis, pathology, and treatment of esophageal motility disorders, with a focus on the recent advances in this field.

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“…The POEM procedure, especially posterior myotomy, involves cutting the clasps and sling fiber at the gastroesophageal junction resulting in an increase in reflux that should be minimized [9]. Even though reflux esophagitis and symptomatic gastroesophageal reflux disease were well controlled by proton pump inhibitors for 3 months [15], the double-scope method can be used to reduce the reflux. Using the double-scope method, incomplete and prolonged myotomy could be avoided toward the gastric side by direct visualization of the tip of the submucosal endoscope through the pediatric scope in the stomach.…”

Section: Discussionmentioning

confidence: 99%

Peroral Endoscopic Myotomy in a Patient with Achalasia Cardia with Prior Heller’s Myotomy

Miftahussurur

Tandan

Makmun

et al. 2020

Case Rep Gastroenterol

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Achalasia cardia is an esophageal myenteric plexus disorder characterized by absence of or incomplete lower esophageal sphincter relaxation and esophageal aperistalsis; Heller's myotomy is the main treatment of choice due to a lower failure rate. Recently, peroral endoscopic myotomy (POEM) has been reported as an alternative treatment for achalasia due to persistent symptoms after Heller's myotomy. An Indian male, aged 18 years, was admitted to the hospital due to dysphagia which had started more than 3 years ago. He also complained of occasional regurgitation and retrosternal pain with Eckardt score 6. Heller's myotomy was performed 2 years ago. Barium swallow showed achalasia cardia and upper gastrointestinal endoscopy found liquid residue and resistance at the gastroesophageal junction. Esophageal manometry is concluded as achalasia cardia type II with a median integrated relaxation pressure (IRP) of 25.6 mm Hg. He underwent POEM; with the help of a submucosal tunnel, an extension of up to 1 cm beyond the gastroesophageal junction could be achieved with a posterior orientation of myotomy. There were no adverse events after the POEM procedure. He was treated with a soft diet for 10 days and other supportive treatments. Following POEM, barium swallow Case 49 showed a significant improvement and esophageal manometry exhibited that the basal lower esophageal sphincter pressure was normal with complete relaxation on swallowing and normal median IRP. The post-procedure Eckardt score was 0. We reported an achalasia patient who received POEM after unsuccessful Heller's myotomy and showed clinical improvement.

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A prospective analysis of GERD after POEM on anterior myotomy

Cited by 58 publications

References 33 publications

Efficacy of peroral endoscopic myotomy compared with other invasive treatment options for the different esophageal motor disorders

Efficacy of peroral endoscopic myotomy compared with other invasive treatment options for the different esophageal motor disorders

Esophageal motility disorders: new perspectives from high-resolution manometry and histopathology

Peroral Endoscopic Myotomy in a Patient with Achalasia Cardia with Prior Heller’s Myotomy

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