Updated Systematic Review of Achalasia, with a Focus on POEM Therapy

Cappell, Mitchell S.; Stavropoulos, Stavros N.; Friedel, David

doi:10.1007/s10620-019-05784-3

Cited by 43 publications

(40 citation statements)

References 180 publications

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“…LHM has been associated with perioperative complications (bleeding [5–18 %], perforation [2 %–5 %], postsurgical infection [3 %–6 %]) 8 9 32 33 . PD has a median perforation rate of 1.9 % 4 8 , and BTI has a temporary effect (mid-term efficacy 22 %–31 %) 11 ; moreover, if a more definite treatment is offered, submucosal fibrosis and mucosal injury rate are increased (4 %–12 %) 2 4 8 . Other options include fully or partially covered SEMS, with variable results (49 %–91 % long-term efficacy and 8 %–45 % AE) 14 15 16 .…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia

et al. 2021

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Backgrounds and study aims Treatment of octogenarian patients with achalasia with conventional treatments is effective but with compromised safety. Biodegradable stents (BS) are promising. We aimed to evaluate their safety, efficacy and clinical outcomes at early, mid and long-term in this population. Patients and methods Naïve or previously-treated achalasic octogenarian patients underwent to BS placement (BSP) between December, 2010 and November, 2011, and were followed-up for 9-years. A strict follow-up was performed. Results Thirty-two patients were included, (17 men [53.1 %]; median age 82 years [78–92]). BSP was performed in all patients. At 9y, 18/32 (56.2 %) completed protocol. Mean BSP time was 37.5±12.1 min and 34.4 % presented thoracic pain. At 1 m, six BS were migrated (18.7 %), requiring a second BSP fixed with hemoclips. At 3 m, twenty-three (72.8 %) completed degradation process. At 6 m, eighteen (56.2 %) presented clinical dysphagia, of whom 5/32 (15.6 %) presented stenotic-tissue hyperplasia, responding to balloon dilation in all cases. Pre-BSP Eckardt, Timed barium esophagram and integrated relaxation pressure improved post-BSP 6 m values (9 vs 2, p = 0.001; < 50 % = 93.8 % vs > 80 % = 81.5 %, p = 0.003 and 18.8 ± 3.2 vs 11.1 ± 2.6 mmHg, p = 0.001, respectively), and there were no significant changes up to 9y post-BSP. Esophagitis grade A or B was presented between 4.7 % to 11.2 % and controlled with PPI. After 9 years we had clinical success rates of 94.4 %, 72 %, and 65.4 % for time point evaluation, per protocol and intention to treat analysis, respectively. Conclusions BSP represents a feasible alternative option in octogenarian patients with achalasia who are high risk with other treatments, presenting acceptable early, mid-, and long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia

et al. 2021

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“…A recent systematic review on POEM reported high clinical efficacy (> 90%), an improvement in quality of life, a reduction in lower oesophageal sphincter pressures and reductions in Eckardt scores. 34 There was a reportable reduction on hospital length of stay with POEM procedures in general as compared to Heller's myotomy, with a cost analysis favouring POEM. 34 There is also evidence in spastic oesophageal disorders with clinical success found to be 92% in type 3 achalasia, 88% in diffuse oesophageal spasm and 72% in Jackhammer oesophagus.…”

Section: Poemmentioning

confidence: 98%

“…34 There was a reportable reduction on hospital length of stay with POEM procedures in general as compared to Heller's myotomy, with a cost analysis favouring POEM. 34 There is also evidence in spastic oesophageal disorders with clinical success found to be 92% in type 3 achalasia, 88% in diffuse oesophageal spasm and 72% in Jackhammer oesophagus. 38 The growth in the evidence of POEM has resulted in a shift in the treatment algorithm of oesophageal motility disorders, with more proceduralists and institutions accepting its utility in practice and therefore, expanding their endoscopic skills.…”

Section: Poemmentioning

confidence: 98%

“…33 There are 3 types of achalasia; type 1 where there is no significant pressurisation in the distal oesophagus, type 2 with pan-oesophageal pressurisations, and type 3 with at least 20% of swallows showing rapidly propagated pressurisation or spastic simultaneous contractions. 34,35 Since its development in 2007, POEM has revolutionized the treatment of achalasia, which until now was limited to Botulinum toxin injection, pneumatic dilatation, and/or surgery. There is now over 8 years of published evidence on the safety and efficacy of POEM in the management in achalasia 36,37 with high clinical success rates.…”

Section: Poemmentioning

confidence: 99%

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Establishing a submucosal endoscopy program in a gastrointestinal unit

Varma

Saxena

2020

Int J Gastrointest Interv

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Establishing a submucosal endoscopy program in a new unit is a difficult but exciting task. There are several key steps and teams involved in the success and failure of this endeavour. Careful thought, planning and implementation at the start will allow an easier transition to the development and progression of this program. An interested gastrointestinal unit with skilled proceduralists holds the key to the commencement of a submucosal program. The opportunity for ongoing learning and training through animal models and simulations, are important for proceduralists to continue to enhance their skills and train other staff. A collaborative team with surgical, nursing and technical support, hospital board approval, and credentialing, as well as the acquisition of appropriate equipment are essential components.

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“…One of the causes of gastrointestinal (GI) motility disorders, including achalasia, is mitochondrial defects[ 2 , 3 ]. Peroral endoscopic myotomy (POEM) is the safest and most effective method for achalasia treatment[ 4 - 7 ].…”

Section: Introductionmentioning

confidence: 99%

Peroral endoscopic myotomy in a pregnant woman diagnosed with mitochondrial disease: A case report

Смирнов¹,

Кирильцева²,

Lyubchenko³

et al. 2021

WJGE

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BACKGROUND Achalasia is a primary esophageal motility disease characterized by impairment of normal esophageal peristalsis and absence of relaxation of the lower esophageal sphincter. Sometimes is can be a part of some genetic disorders. One of the causes of gastrointestinal motility disorders, including achalasia, is mitochondrial defects. CASE SUMMARY We report about a pregnant woman with a history of symptoms associated with inherited mitochondrial disease, which was confirmed by genetic tests, and who was treated via peroral endoscopic myotomy. CONCLUSION Peroral endoscopic myotomy is possible treatment option for a pregnant woman with achalasia caused by mitochondrial disease.

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Updated Systematic Review of Achalasia, with a Focus on POEM Therapy

Cited by 43 publications

References 180 publications

Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia

Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia

Establishing a submucosal endoscopy program in a gastrointestinal unit

Peroral endoscopic myotomy in a pregnant woman diagnosed with mitochondrial disease: A case report

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