Electrical stimulation to increase lower esophageal sphincter pressure after POEM

Ciotola, Franco; Ditaranto, Andres; Bilder, Claudio R.; Badaloni, Adolfo; Lowenstein, Daniel H.; Riganti, Juan Martin; Hoppo, Toshitaka; Jobe, Blair A.; Nachman, Fabio; Nieponice, Alejandro

doi:10.1007/s00464-014-3643-2

Cited by 6 publications

(8 citation statements)

References 22 publications

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“…In the future, technical modifications such as tailoring myotomy length based on real‐time intraoperative electrophysiological measurements using modalities such as EndoFLIP may minimize LES disruption and decrease the incidence of reflux post POEM and LHM. Electrical stimulation of the LES post POEM has also been investigated in animal models for this purpose …”

Section: Discussionmentioning

confidence: 99%

“…Electrical stimulation of the LES post POEM has also been investigated in animal models for this purpose. 43 Despite the lack of evidence favoring one technique over another, POEM has an advantage over LHM as the myotomy site and length can be varied significantly. Although this may not be significant for the treatment of achalasia, it is potentially an ideal endoscopic therapy for refractory spastic esophageal disorders, as it allows myotomy of the LES as well as the more proximal esophagus, where hypertensive contractions occur.…”

Section: Discussionmentioning

confidence: 99%

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Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis

et al. 2015

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Peroral endoscopic myotomy (POEM) is a novel approach to performing esophageal myotomy for the treatment of achalasia. This review aims to assess subjective and objective metrics of achalasia treatment efficacy, perioperative adverse events and the incidence of postoperative gastroesophageal reflux disease in patients treated with POEM. Secondary aims include a pooled analysis comparison of the clinical outcomes and procedural safety of POEM versus laparoscopic Heller's myotomy (LHM). A systematic review of the literature, up to and including January 15, 2015, was conducted for studies reporting POEM outcomes. Studies comparing POEM to LHM were also included for the purpose of pooled analysis. Outcomes from 1122 POEM patients, from 22 studies, are reported in this systematic review. Minor operative adverse events included capno/pneumo-peritoneum (30.6%), capno/pneumo-thorax (11.0%) and subcutaneous emphysema (31.6%). Major operative adverse events included mediastinal leak (0.3%), postoperative bleeding (1.1%) and a single mortality (0.09%). There was an improvement in lower esophageal sphincter pressure and timed barium esophagram column height of 66% and 80% post-POEM, respectively. Symptom improvement was demonstrated with a pre- and post-POEM Eckardt score ± standard deviation of 6.8 ± 1.0 and 1.2 ± 0.6, respectively. Pre- and post-POEM endoscopy showed esophagitis in 0% and 19% of patients, respectively. The median (interquartile range) points scored for study quality was 15 (14-16) out of total of 32. Pooled analysis of three comparative studies between LHM and POEM showed similar results for adverse events, perforation rate, operative time and a nonsignificant trend toward a reduced length of hospital stay in the POEM group. In conclusion, POEM is a safe and effective treatment for achalasia, showing significant improvements in objective metrics and achalasia-related symptoms. Randomized comparative studies of LHM and POEM are required to determine the most effective treatment modality for achalasia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis

et al. 2015

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“…The appealing use of electrical stimulation after POEM has been recently described in an animal model. 8 A significantly re-increased LESP with LES-EST after POEM was observed. However, it was unclear how electrical stimulation would affect impaired muscle tissue such as in achalasia.…”

Section: Discussionmentioning

confidence: 84%

Electrical Stimulation of the Lower Esophageal Sphincter to Treat Gastroesophageal Reflux After POEM

et al. 2018

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As per-oral endoscopic myotomy (POEM) is not followed by any anti-reflux procedure, a common concern is the risk of postoperative gastro-esophageal reflux disease (GERD). Electrical stimulation of the lower esophageal sphincter (LES-EST) could be an option for post-POEM GERD. A 68-year old male obese patient underwent successful POEM but developed GERD not responsive to proton pump inhibitors. Consecutively, the patient had implanted an electrical LES stimulation device, consisting of bipolar LES-electrodes connected to a subcutaneous pulse generator. POEM reduced the Eckardt score (9 vs. 0), the LES resting pressure (52.0 vs. 16.4 mmHg), and the Integrated Relaxation Pressure (62.0 vs. 10.0 mmHg). LES-EST substantially reduced post-POEM GERD symptoms. GERD-HRQL scores indicated the elimination of heartburn (26 vs. 7) and regurgitation (24 vs. 3) at three months. A reduced total number refluxes (82 vs. 14) was observed. The %-time of pH below 4 was only slightly reduced (8.6% to 6.2%).LES-EST appears to be a feasible option to symptomatically treat post-POEM GERD for patients not ideal for conventional anti-reflux surgery.

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“…We were able to find out only two papers published so far that can be partly compared with our study. Ciotola et al (10) performed peroral endoscopic myotomy (POEM) in five pigs. Mean pre-myotomy pressure of the lower oesophageal sphincter was 36 ± 8 mm Hg.…”

Section: Discussionmentioning

confidence: 99%

Oesophageal Manometry in Experimental Pigs: Methods and Initial Experience

Tachecí

Radochová

Kvĕtina

et al. 2015

Acta Med. (Hradec Kralove, Czech Repub.)

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The aim of this study project was to prepare our own method of porcine oesophageal manometry. Ten mature experimental pigs entered the study. Conventional water-perfused system was decided for manometry. Porcine resting and relaxed pressures of the lower oesophageal sphincter are fully comparable with healthy human subjects. Evocable swallowing is doable and oesophageal peristalsis is quantifiable. Basic manometric parameters were different in male and female animals. Oesophageal manometry in experimental pigs is feasible. Porcine oesophageal manometry will be usable for preclinical studies in future.

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Electrical stimulation to increase lower esophageal sphincter pressure after POEM

Abstract: The findings of this study show that LES-EST in healthy animals increases LES pressure after POEM procedure, and could be useful tool to minimize gastroesophageal reflux.

Cited by 6 publications

References 22 publications

Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis

Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis

Electrical Stimulation of the Lower Esophageal Sphincter to Treat Gastroesophageal Reflux After POEM

Oesophageal Manometry in Experimental Pigs: Methods and Initial Experience

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