When is POEM truly equivalent to LHM? A comparison of complication rates during the learning curve

Wong, Wei Jin; Affendi, Nik Arsyad Nik Muhamad; Siow, Sze Li; Mahendran, Hans Alexander; Lau, Peng-Choong; Ho, Shiaw‐Hooi; Mahadeva, Sanjiv

doi:10.1007/s00464-022-09680-2

Cited by 3 publications

(5 citation statements)

References 28 publications

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“…Although performing POEM at the initial stage can be challenging even for experienced endoscopists, Wong et al . demonstrated that the learning curve would flatten, with the complication rates comparable with HM after performing at least 25 cases of POEM 66 . Recent systematic reviews and meta‐analyses have shown that POEM is effective with significant reduction in Eckhardt's score, LES pressure, and improved quality of life after the procedure, compared with HM 67–69 .…”

Section: Resultsmentioning

confidence: 99%

“…[133][134][135] Aside from cost, the availability of expertise will be another consideration especially in this region. 66 There are several limitations in this consensus. Firstly, we may not be able to generalize the applicability of this consensus to other regions.…”

Section: Discussionmentioning

confidence: 97%

“…In contrast, myotomy, either POEM or HM, will be more cost‐effective over the long term due to their durability and lower rate of reintervention 133–135 . Aside from cost, the availability of expertise will be another consideration especially in this region 66 …”

Section: Discussionmentioning

confidence: 99%

“…65 Although performing POEM at the initial stage can be challenging even for experienced endoscopists, Wong et al demonstrated that the learning curve would flatten, with the complication rates comparable with HM after performing at least 25 cases of POEM. 66 Recent systematic reviews and meta-analyses have shown that POEM is effective with significant reduction in Eckhardt's score, LES pressure, and improved quality of life after the procedure, compared with HM. [67][68][69] In terms of long-term efficacy, POEM was similarly reported to be safe and highly effective, with >90% clinical success at >5 years in a longitudinal study of 610 patients in the USA, and the efficacy was further demonstrated in subsequent meta-analyses (Table 3).…”

Section: Statement 11: Pneumatic Dilatation Is An Effective Initial T...mentioning

confidence: 99%

“…Fundoplication can be performed in the same setting as HM to reduce the incidence of reflux after myotomy. 66 Although POEM can be combined with endoscopic fundoplication, this method is not widely practiced, and its efficacy and safety still need to be determined. 83 The frequency of GERD after HM without fundoplication was 31% and decreased significantly to 9% after fundoplication.…”

Section: Statement 15: Fundoplication In Combination With Hm Is Recom...mentioning

confidence: 99%

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Malaysian joint societies' consensus recommendations on diagnosis and management of disorders of esophagogastric junction outflow

Chuah,

Ramasami,

Mahendran

et al. 2023

J of Gastro and Hepatol

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Disorders of esophagogastric junction (EGJ) outflow, including achalasia and EGJ outflow obstruction, are motility disorders characterized by inadequate relaxation of lower esophageal sphincter with or without impaired esophageal peristalsis. Current guidelines are technical and less practical in the Asia–Pacific region, and there are still massive challenges in timely diagnosis and managing these disorders effectively. Therefore, a Malaysian joint societies' task force has developed a consensus on disorders of EGJ outflow based on the latest evidence, while taking into consideration the practical relevance of local and regional context and resources. Twenty‐one statements were established after a series of meetings and extensive review of literatures. The Delphi method was used in the consensus voting process. This consensus focuses on the definition, diagnostic investigations, the aims of treatment outcome, non‐surgical or surgical treatment options, management of treatment failure or relapse, and the management of complications. This consensus advocates the use of high‐resolution esophageal manometry for diagnosis of disorders of EGJ outflow. Myotomy, via either endoscopy or laparoscopy, is the preferred treatment option, while pneumatic dilatation can serve as a secondary option. Evaluation and management of complications including post‐procedural reflux and cancer surveillance are recommended.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Statement 11: Pneumatic Dilatation Is An Effective Initial T...mentioning

confidence: 99%

Section: Statement 15: Fundoplication In Combination With Hm Is Recom...mentioning

confidence: 99%

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Malaysian joint societies' consensus recommendations on diagnosis and management of disorders of esophagogastric junction outflow

Chuah,

Ramasami,

Mahendran

et al. 2023

J of Gastro and Hepatol

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“Into the fire” approach to teaching endoscopic foreign body removal using a modular simulation curriculum

et al. 2022

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Comparative Effectiveness of Peroral Endoscopic Myotomy (POEM) Versus Traditional Treatment Modalities for Achalasia: A Systematic Review

Kasapoglu,

Noor Us Saba,

Hashemi

et al. 2024

Cureus

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Achalasia is a rare esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and absence of peristalsis, leading to significant swallowing difficulties and other symptoms. Traditional treatment options, including Heller myotomy (HM) and pneumatic dilation (PD), have been effective but are associated with risks such as perforation and gastroesophageal reflux disease (GERD). Peroral endoscopic myotomy (POEM) has emerged as a minimally invasive alternative, potentially offering several advantages over conventional methods. This systematic review aims to compare the efficacy, safety, and long-term outcomes of POEM versus HM in the treatment of achalasia. We systematically reviewed studies that compared POEM with HM in achalasia patients, focusing on key outcomes such as myotomy length, operative time, treatment success rates, and complication rates. The review included 15 studies comprising four randomized controlled trials, 10 cohort studies, and one case-control study. The results consistently showed that POEM achieved longer myotomy lengths and shorter operative times compared to HM. POEM also demonstrated higher or comparable treatment success rates, with a uniform definition of success based on achieving an Eckardt score of ≤3. However, the complication rates, particularly the incidence of GERD, varied between the two procedures, highlighting the need for careful patient selection and long-term follow-up. POEM offers a promising alternative to HM for the treatment of achalasia, with advantages in terms of reduced invasiveness, shorter operative times, and potentially higher treatment success rates. However, further high-quality research is necessary to fully establish its long-term efficacy and safety compared to conventional treatments.

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When is POEM truly equivalent to LHM? A comparison of complication rates during the learning curve

Cited by 3 publications

References 28 publications

Malaysian joint societies' consensus recommendations on diagnosis and management of disorders of esophagogastric junction outflow

Malaysian joint societies' consensus recommendations on diagnosis and management of disorders of esophagogastric junction outflow

“Into the fire” approach to teaching endoscopic foreign body removal using a modular simulation curriculum

Comparative Effectiveness of Peroral Endoscopic Myotomy (POEM) Versus Traditional Treatment Modalities for Achalasia: A Systematic Review

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