Peroral endoscopic myotomy for esophageal achalasia: outcomes of the first over 100 patients with short-term follow-up

Shiwaku, Hironari; Inoue, Haruhiro; Yamashita, Kanefumi; Ohmiya, Toshihiro; Beppu, Richiko; Nakashima, Ryo; Takeno, Shinsuke; Sasaki, Takuma; Nimura, Satoshi; Yamashita, Yuichi

doi:10.1007/s00464-016-4813-1

Cited by 62 publications

(53 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our median operation time was 73.0 minutes (range 39 – 184 minutes) whereas previous studies reported a range of 22.9 – 148 minutes 22 23 24 25 . We observed a significant reduction in symptoms: (median [range], preoperative Eckardt score 6 2 3 4 5 6 7 8 9 10 11 vs. postoperative 0 [0 – 4]; P < 0.001), with a significant reduction in IRP (median [range], preoperative 26.0 mmHg [2.3 – 75] vs. postoperative 9 mmHg [0.1 – 23.8]).…”

Section: Discussionmentioning

confidence: 54%

Peroral endoscopic myotomy using FlushKnife BT: a single-center series

et al. 2017

View full text Add to dashboard Cite

Background and study aims Peroral endoscopic myotomy (POEM) is an evolving new treatment strategy for achalasia. Although several kinds of electrosurgical knives have been used in performing POEM, the best device has yet to be determined. The FlushKnife BT is a waterjet-emitting short needle-knife with a small ball tip (BT) that offers the potential to perform all aspects of POEM with a single device. In this study, we evaluated the safety and efficiency of the FlushKnife BT for POEM. Patients and methods A total of 54 consecutive patients with achalasia and other spastic esophageal motility disorders, such as jackhammer esophagus or distal esophageal spasm, who underwent POEM between January 2016 and August 2016, were included in this retrospective study. Results The median operation time was 73.0 minutes (range 39 – 184 minutes). All procedures were completed using only the FlushKnife BT without changing to any other electrosurgical instrument. The median number of additional submucosal injections with an injection needle was 0 (range 0 – 1). Endoscopic vessel sealing was performed a mean of 3 times (range 0 – 7). The median number of bleeding episodes requiring treatment with hemostatic forceps was 0 (range 0 – 5). There were no significant adverse events. Seven of 52 patients (13.5 %) reported symptoms of gastroesophageal reflux disease such as heartburn or acid reflux at 3 month follow-up. Conclusions The FlushKnife BT enabled POEM to be performed with very few device exchanges, either for re-injection or to control intraoperative bleeding. In this uncontrolled case series, the ability of the FlushKnife BT to perform nearly all aspects of the POEM procedure seems to make it particularly well suited to this procedure.

show abstract

Section: Discussionmentioning

confidence: 54%

Peroral endoscopic myotomy using FlushKnife BT: a single-center series

et al. 2017

View full text Add to dashboard Cite

show abstract

“…With recent advances in endoscopic treatment techniques and devices, Inoue et al[9] have developed peroral endoscopic myotomy, in which the myotomy is performed through a submucosal tunnel. Excellent long-term outcomes after POEM have been reported[1,2], and POEM is expected to become a first-line therapy for achalasia requiring surgical intervention. However, some major perioperative adverse events from POEM have also been reported, with mucosal penetration being one of the most dangerous adverse events[1,2,5,6].…”

Section: Discussionmentioning

confidence: 99%

“…Excellent long-term outcomes after POEM have been reported[1,2], and POEM is expected to become a first-line therapy for achalasia requiring surgical intervention. However, some major perioperative adverse events from POEM have also been reported, with mucosal penetration being one of the most dangerous adverse events[1,2,5,6]. Mucosal penetration during POEM occurs at a rate ranging from 4.2%-17.3% depending on the study[1,2,5,7].…”

Section: Discussionmentioning

confidence: 99%

“…However, some major perioperative adverse events from POEM have also been reported, with mucosal penetration being one of the most dangerous adverse events[1,2,5,6]. Mucosal penetration during POEM occurs at a rate ranging from 4.2%-17.3% depending on the study[1,2,5,7]. Treatment for this complication has varied, with some patients undergoing observation without special treatment, being sealed by multiple clips or an endoscopic suture device (OverStitch™ Endoscopic Suturing System; Apollo Endosurgery Austin, Texas), or being treated with the defect being closed using fibrin sealant[11-15].…”

Section: Discussionmentioning

confidence: 99%

“…However, some major perioperative adverse events after POEM have been reported; mucosal penetration is one of the most dangerous adverse events[1,2,5,6]. Mucosal penetration has been reported to occur in 4.2%-17.3% of POEM procedures[1,2,5,7].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy: A retrospective study at a single center

Zhang¹,

Linghu²,

Li³

2017

WJG

View full text Add to dashboard Cite

AIMTo assess the efficacy and safety of fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy (POEM).METHODSTwenty-four patients who underwent POEM and experienced mucosal injury of the cardia during the procedure were retrospectively identified. Of the 24 patients, 21 had mucosal penetration and 3 had only slight mucosal damage without penetration. The 21 patients with mucosal penetration received fibrin sealant for closure at the site of penetration. Penetration-related characteristics, treatment, and recovery were reviewed for all 21 patients to assess the efficacy and safety of fibrin sealant for closure of mucosal penetration at the cardia. Clinical data, including general characteristics, procedure-related parameters, Eckardt scores, lower esophageal sphincter pressures (LESP), and esophagogastroduodenoscopy (EGD) results, were analyzed to determine their influence on treatment success after mucosal penetration during POEM.RESULTSAll 21 patients had a solitary mucosal penetration in the cardia (12 in esophageal region of the cardia, 9 in the stomach region of the cardia, and 1 in both the esophageal and stomach regions). Twelve had a hole-like penetration and 9 had a linear penetration. For those with a hole-like penetration, the mean size was 0.14 cm2 (0.02-0.32 cm2). For those with a linear penetration, the median size was 0.37 cm (0.10-1.00 cm). Closure of the mucosal penetration using fibrin sealant was performed successfully in all 21 patients (two patients required 5 mL fibrin sealant, and the remaining 19 patients required 2.5 mL). Two patients had a nasogastric tube placed for five days after POEM; the remaining 19 patients were kept fasting for 3 d. All 21 patients were discharged after a median of 5 d (range: 5-7 d) postoperatively. During a median 42 mo (range: 9-62 mo) follow-up, all 21 patients with a mucosal penetration successfully healed without the occurrence of infection, ulcer, or esophagitis. Furthermore, the median LESP decreased from 31.9 mmHg (range: 21.9-67.1 mmHg) preoperatively to 20.3 mmHg (range: 6.0-41.0 mmHg) postoperatively (P < 0.05). The median preoperative and postoperative Eckardt scores were 5.0 (range; 4-10) and 1.0 (range: 0-4), respectively (P < 0.05). Of the 21 patients with mucosal penetration, symptom remission, which is defined as a postoperative Eckardt score ≤ 3, was achieved in 20 patients (95.2%) indicating that mucosal penetration did not influence the success of POEM treatment if closed successfully using fibrin sealant.CONCLUSIONFibrin sealant is safe and effective for closure of mucosal penetration during POEM. Mucosal penetrations do not appear to influence the treatment success of POEM if closed successfully using fibrin sealant. Additional studies regarding the feasibility, efficacy, and safety of fibrin sealant for closure of larger mucosal penetrations is warranted.

show abstract