Peroral endoscopic myotomy (POEM) for esophageal achalasia

Inoue, Haruhiro; Minami, Hitomi; Kobayashi, Yasutoshi; Sato, Yuki; Kaga, Makoto; Suzuki, Michitaka; Satodate, Hitoshi; Odaka, Noriko; Itoh, Hiroaki; Kudo, Shin Ei

doi:10.1055/s-0029-1244080

Cited by 1,596 publications

(1,227 citation statements)

References 16 publications

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“…Inoue H. et al performed the first POEM in adults in 2008. [18] The first pediatric POEM was reported in 2012 for a 3-year-old girl with achalasia and Down's syndrome. The child experienced adequate symptom relief when followed for 1 year.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted Heller’s myotomy for achalasia in children

Altokhais

Mandora

Alqahtani

et al. 2016

Computer Assisted Surgery

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Background: Achalasia is rare in children. Surgical options include open, laparoscopic and robotic approaches. However, Heller's myotomy remains the treatment of choice. This report describes our experience with robot-assisted Heller's myotomy in children and presents a review of the literature. Methods: Included in this study are children who underwent robot-assisted Heller's myotomy for esophageal achalasia via the Da Vinci surgical system between 2004 and 2015 at King Saud University Medical City, Riyadh, Saudi Arabia. The medical records of these patients were reviewed for demographic data, presenting symptoms, diagnostic modalities, operative procedures, complications, outcomes and follow-ups. Results: Six patients were identified. The age of the patients at surgery ranged between 2 and 12 years (mean 7.1 years). The most common presenting symptoms were dysphagia, vomiting and nocturnal cough. Contrast swallow and upper gastrointestinal endoscopy established a diagnosis of esophageal achalasia in all of the patients. Four patients underwent esophageal dilatation 2-5 times before the definitive procedure. All patients underwent successful robot-assisted Heller's myotomy with concomitant partial posterior fundoplication. The postoperative course was uneventful. Five patients had a complete resolution of the symptoms and one patient improved. The follow-up assessments have been consistent and have ranged from 0.5 to 11 years (mean 4.4 years). Conclusion: Robotic-assisted Heller's myotomy for esophageal achalasia in children is safe and effective and is a suitable alternative to open and laparoscopic approaches.

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Section: Discussionmentioning

confidence: 99%

Robot-assisted Heller’s myotomy for achalasia in children

Altokhais

Mandora

Alqahtani

et al. 2016

Computer Assisted Surgery

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“…The advent of the peroral endoscopic myotomy (POEM) procedure by Inoue et al in 2008 provided another means of treatment that has been presented worldwide [40]. Initially described by Pasricha et al [41], this form of natural orifice transluminal endoscopic surgery (NOTES) has provided adequate symptom relief, shown similar shortterm results, and is less invasive as compared to laparoscopic Heller myotomy [42].…”

Section: Treatmentmentioning

confidence: 99%

Current status of achalasia management: a review on diagnosis and treatment

Tuason

Inoue

2017

J Gastroenterol

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Background Achalasia is a rare esophageal motility disorder that is characterized by loss of peristalsis and failure of relaxation of the lower esophageal sphincter (LES), particularly during swallowing. This review focuses on the diagnosis of esophageal motility disorders as defined by the Chicago Classification ver 3.0, and presents management options with regard to per-oral endoscopic myotomy (POEM) as the treatment of choice. Methods A concise review of literature was performed for articles related to the management of achalasia, and this was contrasted with our institution's current practice. Results Achalasia is still incompletely understood, and management is focused on establishing a proper diagnosis, and relieving the obstructive symptoms. Conclusions Achalasia should be considered when dysphagia is present, and not otherwise caused by an obstruction or inflammation, and when criteria is met as per the Chicago Classification ver 3.0. Lowering LES tone and disruption of LES can be accomplished by various methods, most notably pneumatic balloon dilatation and surgical myotomy. POEM has been gaining momentum as a first line therapy for achalasia symptoms, and can be considered an important tool for motility disorders of the esophagus.

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“…The term POEM was coined by Inoue et al, who initially reported its usefulness in 17 adult patients with achalasia. 19 Since then, many studies have been published that demonstrate excellent short term outcomes and safety of POEM for achalasia. Reported complications include subcutaneous emphysema, mucosal injury, pneumothorax, pneumomediastinum, pleural effusion, and pneumoperitoneum.…”

Section: Discussionmentioning

confidence: 99%

Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

Nabi

Ramchandani

Reddy

et al. 2016

J Neurogastroenterol Motil

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Background/AimsAchalasia cardia (AC) is a motility disorder, characterized by impaired lower esophageal sphincter relaxation and absence of esophageal peristalsis. AC is rare in children with unclear optimum management strategies. Per oral endoscopic myotomy (POEM) is a novel technique for management of achalasia with encouraging results in adult patients. The efficacy and safety of POEM is not known for pediatric AC. The aim of our study was to evaluate the safety and efficacy of POEM in children with achalasia cardia MethodsThe data of all children (< 18 years) who underwent POEM at our center was retrospectively analysed. Symptoms were analysed using a validated score (Eckardt score) at regular predefined intervals. Objective parameters including high-resolution manometry, timed barium swallow and esophagogastroduodenoscopy were assessed before the procedure and at 1-year follow-up. Clinical success was defined as an Eckardt score ≤ 3. ResultsA total of 15 children underwent POEM during the specified period. Ten out of 15 (10/15) completed 1-year follow-up. Median operative time was 100 (38-240) minutes. Mean pre and post procedure LES pressure were 36.64 ± 11.08 mmHg and 15.65 ± 5.73 mmHg, respectively (P = 0.001). Mean Eckardt score before and after the POEM was 7.32 ± 1.42 and 1.74 ± 0.67, respectively (P = 0.001). Mean percentage improvement in barium emptying at 5 minutes was 63.70 ± 4.46%. All children had complete resolution of symptoms at 1 year. Median weight gain of children at 1 year was 0.65 kg (range, 0.0-4.6). Conclusions

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Peroral endoscopic myotomy (POEM) for esophageal achalasia

Abstract: The short-term outcome of POEM for achalasia was excellent; further studies on long-term efficacy and on comparison of POEM with other interventional therapies are awaited.

Cited by 1,596 publications

References 16 publications

Robot-assisted Heller’s myotomy for achalasia in children

Robot-assisted Heller’s myotomy for achalasia in children

Current status of achalasia management: a review on diagnosis and treatment

Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

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