Endoscopic myotomy in the treatment of achalasia

Ortega, Jose Angel; Madureri, V; Pérez, L.A. Fariña

doi:10.1016/s0016-5107(80)73249-2

Cited by 142 publications

(59 citation statements)

References 8 publications

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“…[3][4][5][6][7] An innovative endoscopic method for dissection of the LES, using a needle-knife to cut the muscular fibers from the lumenal side, was first described by Ortega et al 8 in 1980. Two decades later, Pasricha et al 9 first described the feasibility of an endoscopic submucosal esophageal myotomy in a survival animal model.…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta‐analysis: Efficacy and safety of POEM for achalasia

Barbieri¹,

Hassan²,

Rosati³

et al. 2015

UEG Journal

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Background: Peroral endoscopic esophageal myotomy (POEM) represents a less invasive alternative, as compared with conventional laparoscopic Heller myotomy for treating achalasia patients. In the last years, a number of prospective and retrospective experiences with POEM use for achalasia have been published. Methods: Relevant publications in which patients affected by achalasia underwent POEM treatment were identified by PubMed databases for the period 2010 -2013. From each study, we extracted the number and type of major complications (defined as those requiring any additional medical or surgical intervention). Data were pooled, using random-effects models. Heterogeneity among studies was assessed by using Cochran's Q and the I 2 statistic. Results: We found 16 studies that provided data on 551 patients. The median surveillance period was 6 months (range: 3-12). The median of mean POEM duration was 156 minutes (range: 42-112). Median myotomy length was 10 cm (range: 6-14). Technical and clinical success were reported in 97% (95% CI: 94-98%) and 93% (407/428; 95% CI: 90-95%). No heterogeneity (I 2 ¼ 0%) or publication bias was present in both estimates. When limiting the analysis only to adverse events that require medical or surgical interventions, major adverse events occurred in 14% (95% CI: 11-17%); however, only one patient needed post-POEM surgery (0.2%; 95% CI: 0-0.5%). Conclusions: POEM appeared to be a highly feasible and effective endoscopic treatment for achalasia. Despite POEM being apparently associated with relatively high morbidity, most patients are successfully managed conservatively, so that POEM appears as a very safe procedure; however, POEM should only be performed in centers able to treat POEM complications, such as pneumothorax or pneumoperitoneum.

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Section: Introductionmentioning

confidence: 99%

Systematic review and meta‐analysis: Efficacy and safety of POEM for achalasia

Barbieri¹,

Hassan²,

Rosati³

et al. 2015

UEG Journal

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“…No dissection or retraction is required just for the purpose of reaching the target organ. Moreover, the constricting muscles (i.e., the circular muscles) are the ones that cause this disease [5][6][7]. Dividing the longitudinal muscles just for the purpose of reaching the circular layer is not necessary.…”

Section: Discussionmentioning

confidence: 99%

Transesophageal endoscopic myotomy for achalasia: recognizing potential pitfalls before clinical application

et al. 2011

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The TEEM procedure is technically feasible. Due to the morbidity encountered in the first three pigs, the reported technique was modified to include a slimmer endoscope, a shorter tunnel, and a partial-thickness myotomy. These changes together with an understanding of the pitfalls involved in this procedure led to successful results for the next three pigs. Nevertheless, the authors believe that TEEM is not yet ready for prime time. Perfection of the technique and development of dedicated instruments are mandatory before safe translation of this method to human patients.

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“…LHM has become a first-line approach in the USA for good surgical candidates. A first attempt to develop an endoscopic approach to LES myotomy was reported by Ortega more than 30 years ago [Ortega et al 1980]. These investigators used a modified needle knife to dissect the LES directly through the mucosal layer and demonstrated good short-term clinical, radiologic and manometric results in 17 patients.…”

Section: Per Oral Endoscopic Myotomymentioning

confidence: 99%

Endoscopic approaches to treatment of achalasia

Stavropoulos

Friedel

Modayil

et al. 2012

Therap Adv Gastroenterol

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Endoscopic therapy for achalasia is directed at disrupting or weakening the lower esophageal sphincter (LES). The two most commonly utilized endoscopic interventions are large balloon pneumatic dilation (PD) and botulinum toxin injection (BTI). These interventions have been extensively scrutinized and compared with each other as well as with surgical disruption (myotomy) of the LES. PD is generally more effective in improving dysphagia in achalasia than BTI, with the latter reserved for infirm older people, and PD may approach treatment results attained with myotomy. However, PD may need to be repeated. Small balloon dilation and endoscopic stent placement for achalasia have only been used in select centers. Per oral endoscopic myotomy is a newer endoscopic modality that will likely change the treatment paradigm for achalasia. It arose from the field of natural orifice transluminal endoscopic surgery and represents a scarless endoscopic approach to Heller myotomy. This is a technique that requires extensive training and preparation and thus there should be rigorous accreditation and monitoring of outcomes to ensure safety and efficacy.

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Endoscopic myotomy in the treatment of achalasia

Cited by 142 publications

References 8 publications

Systematic review and meta‐analysis: Efficacy and safety of POEM for achalasia

Systematic review and meta‐analysis: Efficacy and safety of POEM for achalasia

Transesophageal endoscopic myotomy for achalasia: recognizing potential pitfalls before clinical application

Endoscopic approaches to treatment of achalasia

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