Early esophagram in per-oral endoscopic myotomy (POEM) for achalasia does not predict long-term outcomes

Sternbach, Joel M.; Khoury, Rym El; Teitelbaum, Ezra N.; Soper, Nathaniel J.; Pandolfino, John E.; Hungness, Eric S.

doi:10.1016/j.surg.2015.05.023

Cited by 21 publications

(11 citation statements)

References 25 publications

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“…A routine part of post-procedure care at many centers, the role of post-POEM esophagogram has been questioned after several studies reported frequent findings (such as pneumoperitoneum) of no clinical significance while occasional serious AEs were missed [7,8]. Further, day 1 esophagograms do not predict longer-term outcomes [9] but can contribute to delayed discharge [3]. Given these reasons in addition to the overall low rate of esophageal leak at 0.7 % [1], routine esophagogram may be an unnecessary use of our limited healthcare resources, particularly during the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

Rethinking the need for overnight admission after peroral endoscopic myotomy (POEM): a pandemic-driven approach to the future

et al. 2021

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Background and study aims COVID-19 has significantly impacted endoscopic assessment and management of multiple conditions. Our group recommenced treatment of highly symptomatic achalasia patients (Eckardt score ≥ 6) adopting a same-day discharge (SDD) algorithm and present early outcomes of its utilization. Patients and methods We enrolled all outpatients undergoing POEM at a single tertiary referral center. Patients qualified for SDD if all of the following a priori criteria were met: 1) ASA grade I-III; 2) No intraprocedural adverse events (AEs); 3) Secure mucosal closure; 4) Post-procedure pain/nausea responsive to oral medications; and 5) Patients tolerating clear fluids. Results In 17 potential SDD candidates (female 82.4 %, median age 51 years [IQR 48–64]) undergoing POEM, SDD was achieved in 14 (82.4 %). The remaining were admitted due to post-procedure pain/nausea (n = 2) and intraprocedural concerns (capnoperitoneum requiring needle decompression, n = 1). There were no post-procedure AEs or unexpected readmissions. Conclusions This study demonstrates the safety and feasibility of a SDD algorithm for POEM patients and challenges the necessity of routine post-POEM hospital admission. Critically important during the COVID-19 pandemic, this may in fact constitute a changing standard for POEM post-procedure care.

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Section: Discussionmentioning

confidence: 99%

Rethinking the need for overnight admission after peroral endoscopic myotomy (POEM): a pandemic-driven approach to the future

et al. 2021

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“…For instance, in the IPOEMS survey, 88% of those surveyed reported obtaining routine early postoperative radiographic imaging[ 70 ]. Sternbach et al[ 77 ] subsequently evaluated the ability of barium esophagram obtained on postoperative day (POD) 1 in 72 patients undergoing POEM to predict symptomatic and physiologic outcomes at 1-year follow-up. Those patients found to have delayed esophageal emptying on barium esophagram performed on POD 1 had no difference at 1 year with respect to Eckhart scores, barium height at 5 min, or need for retreatment when compared with those patients without delayed emptying on barium esophagram.…”

Section: Per Oral Endoscopic Myotomymentioning

confidence: 99%

Update on the endoscopic treatments for achalasia

Uppal

Wang

2016

WJG

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Achalasia is the most common primary motility disorder of the esophagus and presents as dysphagia to solids and liquids. It is characterized by impaired deglutitive relaxation of the lower esophageal sphincter. High-resolution manometry allows for definitive diagnosis and classification of achalasia, with type II being the most responsive to therapy. Since no cure for achalasia exists, early diagnosis and treatment of the disease is critical to prevent end-stage disease. The central tenant of diagnosis is to first rule out mechanical obstruction due to stricture or malignancy, which is often accomplished by endoscopic and fluoroscopic examination. Therapeutic options include pneumatic dilation (PD), surgical myotomy, and endoscopic injection of botulinum toxin injection. Heller myotomy and PD are more efficacious than pharmacologic therapies and should be considered first-line treatment options. Per oral endoscopic myotomy (POEM) is a minimally-invasive endoscopic therapy that might be as effective as surgical myotomy when performed by a trained and experienced endoscopist, although long-term data are lacking. Overall, therapy should be individualized to each patient’s clinical situation and based upon his or her risk tolerance, operative candidacy, and life expectancy. In instances of therapeutic failure or symptom recurrence re-treatment is possible and can include PD or POEM of the wall opposite the site of prior myotomy. Patients undergoing therapy for achalasia require counseling, as the goal of therapy is to improve swallowing and prevent late manifestations of the disease rather than to restore normal swallowing, which is unfortunately impossible.

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“…In a study by Tatum, the percentage of transit time attributable to EGJ transit and retrograde flow at the EGJ were significantly greater in fundoplication subjects and correlated significantly with dysphagia scores . However, early postoperative esophagrams for detection of leaks cannot predict the symptomatic outcome in patients after treatment of achalasia . Difficulties may arise in the differentiation between reflux‐induced stricture and a too‐narrow wrap.…”

Section: Postoperative Esophagusmentioning

confidence: 99%

What is the role of radiological testing of lower esophageal sphincter function?

Scharitzer¹,

Pokieser

2016

Annals of the New York Academy of Sciences

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Radiological fluoroscopic evaluation remains the primary imaging modality of choice to evaluate patients with swallowing disorders, despite the increasing availability and technical advantages of nonradiological techniques and the current radiological focus on cross-sectional imaging studies, such as computed tomography and magnetic resonance imaging. The radiological swallowing evaluation should be tailored to assess the entire upper gastrointestinal tract, including the lower esophageal sphincter. Fluoroscopy enables the simultaneous assessment of esophageal motility disorders, as well as structural pathologies, including strictures, webs, rings, diverticula, and tumors. Mono- and double-contrast esophagrams and solid bolus tests together allow assessment of lower esophageal sphincter function and complement other methods, such as endoscopy, manometry, or impedance planimetry. Here we review the role of radiological studies for correct assessment of structural and functional pathologies at the level of the lower esophageal sphincter.

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Early esophagram in per-oral endoscopic myotomy (POEM) for achalasia does not predict long-term outcomes

Cited by 21 publications

References 25 publications

Rethinking the need for overnight admission after peroral endoscopic myotomy (POEM): a pandemic-driven approach to the future

Rethinking the need for overnight admission after peroral endoscopic myotomy (POEM): a pandemic-driven approach to the future

Update on the endoscopic treatments for achalasia

What is the role of radiological testing of lower esophageal sphincter function?

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