Peroral endoscopic fundoplication: a brand-new intervention for GERD

Toshimori, Akiko; Inoue, Haruhiro; Shimamura, Yuto; Abad, Mary Raina Angeli; Onimaru, Manabu

doi:10.1016/j.vgie.2020.02.018

Cited by 23 publications

(22 citation statements)

References 6 publications

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“…15 Toshimori et al applied the endoloop and clip method for the initial POEM-F procedure, and refined the technique to the endoscopic hand-suturing to avoid leaving foreign bodies in situ and found decent success in a patient with a follow-up until 10 months. 15 The third factor which needs to be considered is that abnormal AET occurs in only around 50% of patients undergoing POEM. 5,16 In our study, patients had esophagitis on follow-up endoscopy hence, were advised to continue PPI.…”

Section: Discussionmentioning

confidence: 99%

Early outcomes of peroral endoscopic myotomy with fundoplication for achalasia cardia – Is it here to stay?

Patil

Dalal

Maydeo

2020

Digestive Endoscopy

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Background: Peroral endoscopic myotomy with fundoplication (POEM-F) has garnered widespread attention since it tries to achieve an appropriate antireflux procedure during the same setting. The outcomes of POEM-F are currently unexplored.Methods: Patients who underwent POEM-F at our center were retrospectively studied to assess its safety and early outcomes.Results: Twenty patients [70% male; median age 32 years (range 25-41)], with a median symptom duration of 2.1 years (range 1.5-3.7) with achalasia were included. POEM-F procedure was completed in a median of 118 min (range 90-160), with 17/20 (85%) technical success. The median hospitalization was 4 days (range 2-7). Capnothorax (n = 3), resolved spontaneously (n = 2) in 4-6 h, while in one patient (n = 1) the endoscope inadvertently entered into the thoracic cavity for which prophylactic intercostal drain was required.Capnoperitoneum was seen in 17/17 (100%) patients who underwent fundoplication, subcutaneous emphysema in 8/17 (47%) patients. At 1-month follow-up endoscopy, 5/17 (29.4%) patients had loosening of the fundal wrap, 3/17 (17.6%) patients had ulceration in fundus and in gastroesophageal junction due to underlying hemoclips. At 3 months, loosening of the fundal wrap was seen in 7/17 (41.2%) patients. A 24-h pH-metry revealed abnormal esophageal acid exposure in 7/17 (41.2%) patients, while it was normal in those patients in whom the fundal wrap was maintained. 10/17 (58.8%) patients were off proton pump inhibitors. Conclusion:POEM-F is technically feasible with reasonable short term success. However, the durability, early success and safety of POEM-F need reassessment in long-term studies before being applied in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Early outcomes of peroral endoscopic myotomy with fundoplication for achalasia cardia – Is it here to stay?

Patil

Dalal

Maydeo

2020

Digestive Endoscopy

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“…To close the deficient muscle layer in the diverticulum, the muscle layer at the entry of the diverticulum was stitched together by using the endoscopic suturing method using an endoscopic needle holder (E650007, prototype; Olympus Corp). 4 We prepared a surgical suture needle (VLOCL0804; Covidien, Mansfield, Mass, USA) with a self-made anchor made from a fragment of PLEDGET (commonly used in cardiovascular surgery) ( Fig. 6 ).…”

Section: Endoscopic Methodsmentioning

confidence: 99%

Peroral endoscopic myotomy with diverticulum resection

et al. 2020

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“…[36] Toshimori et al have reported POEF (which is POEM+F in two independent sessions) as a subsequent second procedure to control post-POEM GER. [25] The authors also demonstrated use of endoscopic suturing instead of endoloop and clips to create the wrap. It will be interesting to evaluate which of these techniques can provide a more robust and secure fundoplication in the long term.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…[22,23] In an attempt to reduce post POEM GER, Inoue et al described a novel endoscopic fundoplication following anterior POEM, either as a single-stage concomitant procedure (POEM+F) or later as a separate subsequent procedure (POEF). [24,25] The procedure aimed to replicate surgical (laparoscopic) Dor's partial fundoplication. In their first series of 21 patients, the authors reported reduction in reflux symptoms and optimum maintenance of the fundoplication wrap at one-month follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Single-session endoscopic fundoplication after peroral endoscopic myotomy (POEM+F) for prevention of post gastroesophageal reflux – 1-year follow-up study

et al. 2020

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Background and Aim Peroral endoscopic myotomy (POEM) is an established treatment for achalasia cardia (AC), however post-POEM gastroesophageal reflux (GER) remains a significant problem. Concomitant endoscopic fundoplication following POEM (POEM+F) was recently described to reduce post-POEM GER. This single-center study reports medium-term outcomes of POEM+F. Patients and Methods Retrospective analysis of prospectively maintained database of patients undergoing POEM+F. Abstracted data – demographics, achalasia type, pre-POEM Eckardt score (ES), prior therapy, follow-up. Follow-up was 3-monthly for one-year. Follow-up assessments included post-POEM ES, GerdQ score, EGD – wrap integrity and esophagitis, and pH studies. GER was defined according to Lyon consensus. Data was recorded as mean (SD) or median (IQR), P-value < 0.05 was considered statistically significant. Results 25 patients underwent POEM+F, mean age (SD) – 40.13 (13.66) years, 12 females. POEM+F was technically successful in 23/25 (92%). Significant dysphagia improvement was seen in all 25 (mean [SD] pre- and post-POEM ES 8.21 [1.08] and 0.1 [0.3] respectively, p < 0.05). Mean total procedure and fundoplication time (SD) – 115.6 (27.2) and 46.7 (12.4) minutes respectively. Time reduced significantly after initial 5 cases. Median follow-up was 12-months (IQR 9 – 13). Intact wrap was seen in 19/23 (82.6%). GER (abnormal EAET) was seen in 2/18 (11.1%); one reported GerdQ > 8. Borderline GER (asymptomatic grade A esophagitis, normal EAET) was identified in 4/22 (18.1%). Two (8%) minor delayed adverse events required no intervention. Conclusions POEM+F is safe and reproducible. At 12-months follow-up, incidence of post-POEM+F GER was low and acceptable.

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Peroral endoscopic fundoplication: a brand-new intervention for GERD

Cited by 23 publications

References 6 publications

Early outcomes of peroral endoscopic myotomy with fundoplication for achalasia cardia – Is it here to stay?

Early outcomes of peroral endoscopic myotomy with fundoplication for achalasia cardia – Is it here to stay?

Peroral endoscopic myotomy with diverticulum resection

Single-session endoscopic fundoplication after peroral endoscopic myotomy (POEM+F) for prevention of post gastroesophageal reflux – 1-year follow-up study

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