POEM in the Treatment of Esophageal Disorders

Parsa, Nasim; Khashab, Mouen A.

doi:10.1007/s11938-018-0168-0

Cited by 12 publications

(14 citation statements)

References 98 publications

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“…In the elderly, on account of associated diseases, endoscopic treatment is used as the first line. The clinical success rate in our study for this subgroup was similar to the overall success rate [20,21].…”

Section: Discussionsupporting

confidence: 84%

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POEM: Five Years of Experience in a Single East European Center

Tefas

Boroș²,

Ciobanu

et al. 2020

JGLD

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Background and Aims: Achalasia is an esophageal motility disorder with many available therapies. Peroral endoscopic myotomy (POEM) is a therapeutic alternative to surgical myotomy, harboring significant potential short term advantages. Our aim was to analyze a single-series POEM’s learning curve, safety and efficiency over short, medium and long-terms in an East European Center. Methods: This observational, prospective study was carried out in the Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. Patients with symptomatic achalasia (Eckardt score>3) and pre-op evaluations consistent with the diagnosis of achalasia were included. All POEMs were performed by a highly skilled endoscopist. All patients were allowed to eat 48 hours after POEM. An esophagography was performed in all patients to exclude any leakage. The patients were asked to return for follow-up at established intervals: 1 month, 6 months, 12 months, and annually thereafter. Results: 136 patients were included with an average duration of symptomatology of 36.75 months. The procedure was technically successful in all patients, while a clinical success rate was achieved in 87.5% (n=119) of patients after one POEM session. The success rate was 92.64% after 6 months, 91.17% after one year, 88.9% after 2 years, and 87.5% after 3 years or more; 12.5% of patients required additional treatment. Eighteen patients (13.23%) presented major early complications. Gastroesophageal reflux disease was encountered in 16 patients immediately after POEM and in 22 patients at subsequent follow-ups. Conclusion: POEM is a safe and effective minimally invasive therapeutic option which can substitute surgical myotomy, having a high success rate and a low rate of adverse events in short, medium and long-term.

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Section: Discussionsupporting

confidence: 84%

“…Over followup, none of the four patients required additional treatment after POEM. The efficiency of POEM for pediatric patients with achalasia seems to be better compared with pneumatic dilatation [21] with Nabi et al presenting a clinical success of POEM therapy in over 95% for patients under 18 years old [22].…”

Section: Discussionmentioning

confidence: 99%

POEM: Five Years of Experience in a Single East European Center

Tefas

Boroș²,

Ciobanu

et al. 2020

JGLD

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“…This was a retrospective, international, multicenter cohort study including 11 tertiary centers (2 from the United States, 7 from Europe, 2 from Asia). The total number of patients contributed by each center were as follows: Gemelli University Hospital, Italy (101), Hirslanden Private Clinic Group, Zürich (19), Deenanath Mangeshkar Hospital, India (18), Johns Hopkins Hospital, US (17), Edouard Herriot hospital, France (13), CHA Bundang Hospital, South Korea (7), Cochin Hospital, France (6), Metropolitan Hospital, Greece (5), Kingʼs College Hospital, UK (3), Iuliu Haţieganu University of Medicine and Pharmacy, Romania (2), NorthShore University HealthSystem, United States (2). Institutional Review Board approval was obtained at all institutions for chart review and patient follow-up.…”

Section: Methodsmentioning

confidence: 99%

“…Per-oral endoscopic myotomy (POEM) is a minimally invasive endoscopic technique for the treatment of achalasia and spastic esophageal disorders. It has been increasingly adopted worldwide with more than 7000 procedures performed to date [1,2].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study

et al. 2020

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Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clinical response of 82 % to 100 % in treatment of patients with achalasia. Data are limited on the long-term durability of the clinical response in these patients. The aim of this study was to determine the long-term outcomes of patients undergoing POEM for management of achalasia. Methods This was a retrospective multicenter cohort study of consecutive patients who underwent POEM for management of achalasia. Patients had a minimum of 4 years follow-up. Clinical response was defined by an Eckardt score ≤ 3. Results A total of 146 patients were included from 11 academic medical centers. Mean (± SD) age was 49.8 (± 16) years and 79 (54 %) were female. The most common type of achalasia was type II, seen in 70 (47.9 %) patients, followed by type I seen in 41 (28.1 %) patients. Prior treatments included: pneumatic dilation in 29 (19.9 %), botulinum toxin injection in 13 (8.9 %) and Heller myotomy in seven patients (4.8 %). Eight adverse events occurred (6 mucosotomies, 2 pneumothorax) in eight patients (5.5 %). Median follow-up duration was 55 months (IQR 49.9–60.6). Clinical response was observed in 139 (95.2 %) patients at follow-up of ≥ 48 months. Symptomatic reflux after POEM was seen in 45 (32.1 %) patients, while 35.3 % of patients were using daily PPI at 48 months post POEM. Reflux esophagitis was noted in 16.8 % of patients who underwent endoscopy. Conclusion POEM is a durable and safe procedure with an acceptably low adverse event rate and an excellent long-term clinical response.

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“…pneumatic dilation (PD), botox injection), and surgical procedures (i.e. Heller myotomy (HM)) 2. Since per oral endoscopic myotomy (POEM) was originally reported in 2010 by Inoue,3 POEM has been increasingly performed as one of the first‐line treatment options, and many studies have shown its safety and efficacy 4-11…”

Section: Introductionmentioning

confidence: 99%

Per oral endoscopic myotomy as salvage therapy in patients with achalasia refractory to endoscopic or surgical therapy is technically feasible and safe: Systematic review and meta‐analysis

Hashimoto

Inoue

Shimamura

et al. 2020

Digestive Endoscopy

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Backgrounds and aims Per oral endoscopic myotomy (POEM) has been reported as an effective and safe salvage therapy for achalasia but there is limited composite data. We performed a systematic review and meta‐analysis of studies that reported the rates of clinical success and adverse events among patients who underwent POEM after failed conventional endoscopic or surgical therapy. Methods Electronic literature search was conducted from inception through December 2018 for articles reporting the efficacy and safety of POEM in patients with achalasia who failed endoscopic or surgical therapy. Primary outcome was the pooled estimated rates of clinical success, defined as Eckardt score ≤ 3 after POEM. Secondary outcomes were procedural time, the rates of POEM‐related gastroesophageal reflux disease (GERD) and procedure‐related adverse events. Results Seven studies reporting outcomes on 487 patients met our criteria. Pooled estimated rate of clinical success of POEM was 88% (95% confidence interval (CI) 79–94%). Mean procedural time was 64 minutes (95% CI 44–85 minutes). POEM‐related GERD was found in 20% (95% CI 16–24%) of patients. Estimated incidence of overall adverse events was 10% (95% CI 5–18%) with individual risk of bleeding, mucosotomy, pneumothorax, pneumoperitoneum hydrothorax/mediastinitis, and subcutaneous emphysema ranging from 1 to 4%. Conclusions Per oral endoscopic myotomy after failed endoscopic or surgical therapy in patients with achalasia is an effective and safe treatment. Further long‐term follow‐up studies in a larger number of patients are warranted to validate the sustainable efficacy of POEM for achalasia.

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POEM in the Treatment of Esophageal Disorders

Cited by 12 publications

References 98 publications

POEM: Five Years of Experience in a Single East European Center

POEM: Five Years of Experience in a Single East European Center

Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study

Per oral endoscopic myotomy as salvage therapy in patients with achalasia refractory to endoscopic or surgical therapy is technically feasible and safe: Systematic review and meta‐analysis

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