Third-space endoscopy: the final frontier

Hayat, Maham; Yang, Dennis; Draganov, Peter V.

doi:10.1093/gastro/goac077

Cited by 7 publications

(3 citation statements)

References 98 publications

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“…All G-POEM procedures were performed by two providers (DY and MKH) with experience in submucosal endoscopy. The procedures were performed as previously described in the literature 20 21 22 23 . In brief, all cases were under general anesthesia with the patient in left lateral decubitus position.…”

Section: Methodsmentioning

confidence: 99%

Quantification of interstitial cells of Cajal and fibrosis during gastric per-oral endoscopic myotomy and its association with clinical outcomes

Yang,

Hasan,

Bani Fawwaz

et al. 2024

Endosc Int Open

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Background and study aims Alterations to interstitial cells of Cajal (ICC) and collagen fibrosis have been implicated in the pathogenesis of gastroparesis. We aimed to evaluate the feasibility and safety of pyloric muscle sampling during gastric peroral endoscopic myotomy (G-POEM) and the association between pyloric ICC density and degree of fibrosis with clinical outcomes. Patients and methods This was a single-center prospective study of gastroparetic patients who underwent G-POEM and intraprocedural pyloric muscle biopsies between January 2022 and April 2023. ICC count was estimated using CD117 stain and trichome for collagen fibrosis. Clinical response to G-POEM was defined as an improvement of ≥ 1 point on the Gastroparesis Cardinal Symptom Index. Results Fifty-six patients (median age 60 years, 71.4% women) underwent G-POEM (100% technical success; 71.4% clinical response). ICC depletion (< 10/high-power field) and fibrosis were encountered in 70.4% and 75% of the cases, respectively. There was no difference in mean ICC count between G-POEM responders vs. non-responders (7±3.6 vs. 7.7±3.3; P= 0.9). There was no association between ICC density or degree of fibrosis with the etiology of gastroparesis, duration of symptoms, gastric emptying rate, or pyloric impedance planimetry. Patients who did not respond to G-POEM had a significantly higher degree of moderate/severe fibrosis when compared with those who responded (81.3% vs. 25%; P = 0.0002). Conclusions Pyloric muscle biopsies during G-POEM was feasible and safe. ICC depletion and pyloric muscle fibrosis are common in gastroparetic patients. The degree of fibrosis may be related to pyloric dysfunction and clinical response to G-POEM. Additional studies are needed to confirm these results.

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Section: Methodsmentioning

confidence: 99%

Quantification of interstitial cells of Cajal and fibrosis during gastric per-oral endoscopic myotomy and its association with clinical outcomes

Yang,

Hasan,

Bani Fawwaz

et al. 2024

Endosc Int Open

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“…POEM, the first successful innovative technique in third-space endoscopy, has emerged as the preferred treatment for achalasia and other esophageal spastic disorders [60,61]. The procedure involves several key steps: mucosal incision, submucosal dissection, myotomy, and mucosal closure [62]. When establishing the submucosal tunnel, it is essential to perform a thorough submucosal injection to ensure an excellent surgical field.…”

Section: Poemmentioning

confidence: 99%

Application of electrosurgery in gastrointestinal endoscopy

Wang,

Zhao,

Zhou

2024

PMD

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With the continuous advancement in medical device technology, minimally invasive surgery has become the cornerstone of modern surgical practices. At the forefront of this evolution is the fusion of medical endoscopes with high-frequency electrosurgical instruments, now a mainstream approach in minimally invasive surgeries, driving the development of innovative surgical procedures. This paper aims to provide an in-depth understanding of the principles of electrosurgical units, with a particular focus on standard procedures in gastrointestinal endoscopic electrosurgery. The goal of this review is to provide a more profound and comprehensive insight into endoscopic electrosurgery for medical practitioners and patients. Through the comprehensive study, it is anticipated to serve as a guide and reference for improving surgical outcomes, reducing patient discomfort, and simplifying the tasks of healthcare professionals.

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“…Peroral endoscopy myotomy (POEM) is a minimally invasive procedure of the so called “third space”. The overarching principal is creation of a mucosal incision, careful dissection of the submucosal space with electrosurgical knives (i.e., tunneling), myotomy, and finally closure of the mucosal incision [ 1 ]. This procedure was originally applied to the treatment of achalasia (E-POEM), and later to Zenker diverticulum (Z-POEM), gastroparesis (G-POEM), and epiphrenic diverticulum (D-POEM) [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Peroral endoscopic myotomy for the management of symptomatic cricopharyngeal bar (C-POEM): a case series and video demonstration

Norton

2024

aog

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Background A cricopharyngeal bar refers to a radiological description of a prominent cricopharyngeal muscle. While these may be incidental, they can lead to significant oropharyngeal dysphagia due to incoordination of the upper esophageal sphincter and true luminal narrowing. Various treatments have been used for the management of cricopharyngeal bar, including botulinum toxin injection, dilation, and surgical myotomy. Cricopharyngeal peroral endoscopic myotomy (C-POEM) is a novel procedure that uses the principles of “third-space” endoscopy to treat symptomatic cricopharyngeal bar. Methods We report a retrospective case series of 5 patients referred with oropharyngeal dysphagia to 2 UK tertiary referral centers between 2022 and 2023 who subsequently underwent C-POEM. Technical success was defined as completion of all steps of the C-POEM procedure and clinical success as a reduction in the pre-treatment Dakkak and Bennett score to ≤1, or 0 if the pre-treatment score was 1. Results C-POEM was associated with a technical success of 100% and clinical success of 100% over a median follow up of 2 months (interquartile range 1-8). There was 1 adverse event due to a small mucosal defect and associated leak on barium swallow, which was the result of difficult access during mucosal closure. This was managed conservatively with antibiotics. A step-by-step video demonstration of the procedure is provided. Conclusion C-POEM offers an alternative upfront therapy for symptomatic cricopharyngeal bar, but should be undertaken by endoscopists with significant experience in third-space endoscopy in view of the difficulty of working within the hypopharynx.

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Third-space endoscopy: the final frontier

Cited by 7 publications

References 98 publications

Quantification of interstitial cells of Cajal and fibrosis during gastric per-oral endoscopic myotomy and its association with clinical outcomes

Quantification of interstitial cells of Cajal and fibrosis during gastric per-oral endoscopic myotomy and its association with clinical outcomes

Application of electrosurgery in gastrointestinal endoscopy

Peroral endoscopic myotomy for the management of symptomatic cricopharyngeal bar (C-POEM): a case series and video demonstration

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