Per-oral Endoscopic Myotomy

Liu-Burdowski, Jennifer; Duarte-Chavez, Rodrigo; Kahaleh, Michel

doi:10.1097/mcg.0000000000001620

Cited by 4 publications

(2 citation statements)

References 59 publications

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“…In our opinion, it will take some time for the literature to reveal whether endoscopic or surgical myotomy is the best long-term option for the treatment of achalasia. Two crucial points that weigh unfavorably on the POEM procedure, in terms of the possibility that it will come to be widely indicated for the treatment of achalasia[ 66 , 67 ]. The first is the paucity of high-quality (randomized) technical studies comparing POEM with the well-established techniques of pneumatic dilatation of the cardia and laparoscopic myotomy with fundoplication, which could show, at least, the noninferiority of POEM.…”

Section: Discussionmentioning

confidence: 99%

Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial

Moura¹,

Jukemura²,

Ribeiro³

et al. 2022

WJG

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BACKGROUND Achalasia is a rare benign esophageal motor disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES). The treatment of achalasia is not curative, but rather is aimed at reducing LES pressure. In patients who have failed noninvasive therapy, surgery should be considered. Myotomy with partial fundoplication has been considered the first-line treatment for non-advanced achalasia. Recently, peroral endoscopic myotomy (POEM), a technique that employs the principles of submucosal endoscopy to perform the equivalent of a surgical myotomy, has emerged as a promising minimally invasive technique for the management of this condition. AIM To compare POEM and laparoscopic myotomy and partial fundoplication (LM-PF) regarding their efficacy and outcomes for the treatment of achalasia. METHODS Forty treatment-naive adult patients who had been diagnosed with achalasia based on clinical and manometric criteria (dysphagia score ≥ II and Eckardt score > 3) were randomized to undergo either LM-PF or POEM. The outcome measures were anesthesia time, procedure time, symptom improvement, reflux esophagitis (as determined with the Gastroesophageal Reflux Disease Questionnaire), barium column height at 1 and 5 min (on a barium esophagogram), pressure at the LES, the occurrence of adverse events (AEs), length of stay (LOS), and quality of life (QoL). RESULTS There were no statistically significant differences between the LM-PF and POEM groups regarding symptom improvement at 1, 6, and 12 mo of follow-up ( P = 0.192, P = 0.242, and P = 0.242, respectively). However, the rates of reflux esophagitis at 1, 6, and 12 mo of follow-up were significantly higher in the POEM group ( P = 0.014, P < 0.001, and P = 0.002, respectively). There were also no statistical differences regarding the manometry values, the occurrence of AEs, or LOS. Anesthesia time and procedure time were significantly shorter in the POEM group than in the LM-PF group (185.00 ± 56.89 and 95.70 ± 30.47 min vs 296.75 ± 56.13 and 218.75 ± 50.88 min, respectively; P = 0.001 for both). In the POEM group, there were improvements in all domains of the QoL questionnaire, whereas there were improvements in only three domains in the LM-PF group. CONCLUSION POEM and LM-PF appear to be equally effective in controlling the symptoms of achalasia, shortening LOS, and minimizing AEs. Nevertheless, POEM has the advantage of improving all domains of QoL, and shortening anesthesia and procedure times but with a significantly higher rate of gastroesophageal reflux.

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Section: Discussionmentioning

confidence: 99%

Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial

Moura¹,

Jukemura²,

Ribeiro³

et al. 2022

WJG

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“…The POEM procedure was performed at our center by the principle investigator, as recently described by Liu-Burdowski et al 19 …”

Section: Methodsmentioning

confidence: 99%

Peroral Endoscopic Myotomy Is an Effective Treatment Option for Managing Jackhammer Esophagus

Canakis

Xie

Kim

2022

Journal of Clinical Gastroenterology

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Background and Aims: Jackhammer esophagus (JE) is a rare hypercontractile motility disorder often associated with dysphagia, regurgitation, and chest pain. In patients with clinically relevant symptoms, treatment options aim to decrease esophageal contractions. Medical, endoscopic and surgical therapies have limited long-term efficacy. The advent of peroral endoscopic myotomy (POEM) has evolved as a minimally invasive treatment option. Yet data regarding JE is scare. As such we aimed to investigate the clinical efficacy of JE. Patients and Methods: This was a single center retrospective study of consecutive adult patients undergoing POEM for JE from April 2018 to September 2021. All procedures were conducted by a single endoscopist. Primary outcome was clinical success, defined as Eckardt score (ES) ≤3 following the procedure. Results: A total of 13 patients (mean age 58, 7 females) underwent POEM with a mean duration of symptoms of 42.6 months. Preprocedure mean ES was 8.92. Nine patients were treatment naive. Pre-POEM endoluminal functional luminal imaging probe (n=10) demonstrated a distensibility index of 0.34. The average length of follow-up after POEM was 15.8 months. There was a 92.3% (12/13) clinical success rate, with a mean post-POEM ES of 1.53. One patient’s ES improved from 12 to 1 after POEM; however, 2.5 years later she developed recurrent symptoms (ES 10). Only 1 patient had endoscopic evidence of Los Angeles grade A esophagitis. One year after POEM, 5 patients had gastroesophageal reflux disease symptoms, but only 2 required acid suppression therapy. Conclusion: POEM is an effective treatment modality with long-term efficacy. Larger, prospective studies are needed to validate these findings.

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Active narcotic use and post–peroral endoscopic myotomy outcomes in esophageal motility disorders

Xue,

Canakis,

Lee

et al. 2024

Gastrointestinal Endoscopy

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Per-oral Endoscopic Myotomy

Cited by 4 publications

References 59 publications

Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial

Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial

Peroral Endoscopic Myotomy Is an Effective Treatment Option for Managing Jackhammer Esophagus

Active narcotic use and post–peroral endoscopic myotomy outcomes in esophageal motility disorders

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