Endoscopic Myotomy For Achalasia Research Articles

Novel scale for evaluating the therapeutic efficacy of per-oral endoscopic myotomy in achalasia.

Symptom scales for achalasia after per-oral endoscopic myotomy (POEM) are lacking. This study aimed to propose a new scale based on the conventional Eckardt score (c-ES) and evaluate persistent symptoms that impair patients' quality of life (QOL) post-POEM. Dysphagia, regurgitation, and chest pain frequencies were assessed using a 6-point scale modified-ES (m-ES) after POEM, with "occasional" symptoms on the c-ES further subdivided into three-period categories on m-ES. Symptom severity was further evaluated using a 5-point scale ranging from 1 to 5 points, with a score ≥ 3 points defined as persistent symptoms impairing QOL. We analyzed the correlation between the m-ES and severity score, diagnostic performance of the m-ES for persistent symptoms, and overlaps between each residual symptom. Overall, 536 patients (median follow-up period, 2.9years) post-POEM were included in this multicenter study. Significant correlations were observed between the m-ES and severity scores for dysphagia (r = 0.67, p < 0.01), regurgitation (r = 0.73, p < 0.01), and chest pain (r = 0.85, p < 0.01). Twenty-six patients (4.9%) had persistent symptoms post-POEM, and 23 of them had m-ES-specific symptom frequency ≥ once a month, which was determined as the optimal frequency threshold for screening persistent symptoms. The total m-ES predicted persistent symptoms more accurately than the total c-ES (area under the curve: 0.95 vs. 0.79, p < 0.01). Furthermore, dysphagia and chest pain were the major residual symptoms post-POEM covering 91.4% of regurgitation. The new post-POEM scale successfully evaluated the QOL-based patient symptom severities. Our study implied the possibility of a simpler scale using residual dysphagia and chest pain.

Oral 10% concentrated sodium chloride for preoperative preparation of peroral endoscopic myotomy in achalasia of cardia: a simple and effective method

Oral 10% concentrated sodium chloride for preoperative preparation of peroral endoscopic myotomy in achalasia of cardia: a simple and effective method

The Impact of Early Nutrition Following Peroral Endoscopic Myotomy in Achalasia: A Tertiary Center Experience.

This retrospective single-center study aimed to assess the safety of early feeding in patients who met certain criteria following peroral endoscopic myotomy (POEM). Data from 100 patients who underwent POEM at our center between January and December 2022 were collected. Early feeding was defined as the introduction of clear liquid foods at 4 hours post procedure. At 4 and 24 hours, the pain was rated using the visual analog scale (VAS) in all patients. Patients without intraoperative complications (pneumoperitoneum requiring needle drainage, severe arterial bleeding requiring the use of hemostatic forceps, severe mucosal injury) and severe pain (VAS score > 6) and nausea-vomiting at the fourth postoperative hour were given the early feeding approach. In patients who did not meet these requirements, enteral feeding was initiated after 24 hours (late feeding). Among the 100 patients, 50 patients were categorized early feeding. No patients had a control esophagogram. In the early and late enteral feeding groups, VAS scores were 4 (0-6) and 6 (1-8) (P< 001) at 4 hours and 1 (0-3) and 1 (0-6) (P = .043) at 24 hours, respectively. No severe complications were developed after early feeding. The median hospital stay in the early feeding group was 1 (1-3) day. There was no emergency readmission in any of early feeding patients. Our study showed early feeding following POEM can be begun in achalasia patients who do not have intraoperative complications, severe pain, or nausea/vomiting.

S1313 Predictors of Mortality After Heller Myotomy and Peroral Endoscopic Myotomy in Achalasia

S1313 Predictors of Mortality After Heller Myotomy and Peroral Endoscopic Myotomy in Achalasia

S1312 Predictors of Complications After Heller Myotomy and Peroral Endoscopic Myotomy in Achalasia

S1312 Predictors of Complications After Heller Myotomy and Peroral Endoscopic Myotomy in Achalasia

S582 Need for Reinterventions After Per Oral Endoscopic Myotomy in Achalasia

S582 Need for Reinterventions After Per Oral Endoscopic Myotomy in Achalasia

Risk factors for clinical failure of peroral endoscopic myotomy in achalasia.

The recent development of per oral endoscopic myotomy (POEM) has been a game changer in the management of patients with achalasia. However, approximately 1 in 10 patients will not experience clinical success. The aim of this mini-review is to describe the current state of knowledge about the risk factors associated with POEM failure for the treatment of achalasia. Suspected risk factors are detailed into pre-, intra-, and post-procedural factors and put into perspective. Pre-procedural factors have been described, such as pre-treatment Eckardt score, previous treatments for achalasia, sigmoid type esophagus, significant esophageal dilatation, non-type II achalasia, young age and long duration of symptoms. An intra-procedural factor, mucosal injury during POEM, has also been associated with POEM failure. The occurrence of post-POEM GERD was identified as a controversial post-procedural factor associated with failure. The presumed mechanisms of POEM failure are incomplete myotomy or ineffective LES disruption, as confirmed by high-resolution manometry. However, when manometry confirms a significant decrease in LES pressure, it is likely that either impaired peristalsis or a morphologic abnormality such as extreme esophageal dilatation or severe tortuosity, which are not treated by POEM, should be suspected. Notably, a recently described adverse effect of POEM is the formation of a pseudo-diverticulum at the site of the myotomy (blown out myotomy). We finally stress the importance of performing a complete workup in case of POEM failure as different mechanisms of POEM failure should lead to different management.

The relationship between cardiac muscularis propria and clinical outcomes of peroral endoscopic myotomy in achalasia

Background and aimAchalasia patients usually present lower esophageal sphincter thickening, which can impact the expansibility of cardia. We aimed to investigate the effect of cardiac muscularis propria (MP) on perioperative adverse events (AEs) and treatment outcomes of patients treated with peroral endoscopic myotomy (POEM). MethodsWe retrospectively reviewed 114 patients with achalasia undergoing pre-POEM endoscopic ultrasonography (EUS) between May 2013 and November 2019. Cardiac MP thickness was measured using EUS. POEM failure was defined as Eckardt score >3. Risk factors for perioperative AEs and POEM failure were identified. ResultsPatients were divided into the thin (n = 52) and the thick group (n = 62) based on the median of cardiac MP thickness (3.0 mm). Perioperative AEs rate of the thin group seemed to be slightly higher than that of the thick group (11.5% vs. 4.8%, P = 0.30). During a median follow-up of 30 months (range 1–77), 100 patients completed follow-up, 16 (16%) of which occurred clinical failure. The clinical outcomes of patients in the thin group were significantly poorer than those patients in the thick group (P = 0.006). Cardiac MP thickness was an independent risk factor for POEM failure (hazard ratio 3.9, P = 0.02; Cox regression), but not the risk factor for perioperative AEs (odds ratio 2.6, P = 0.2; logistic regression). ConclusionCardiac MP thickness could be a novel predictive factor for POEM failure in patients with achalasia.

Clinical Success and Correlation of Eckardt Scores with Barium Esophagram After Peroral Endoscopic Myotomy in Achalasia

Clinical Success and Correlation of Eckardt Scores with Barium Esophagram After Peroral Endoscopic Myotomy in Achalasia

Obesity Does Not Impact Outcomes or Rates of Gastroesophageal Reflux After Peroral Endoscopic Myotomy in Achalasia.

Outcomes of laparoscopic Heller myotomy in obese patients with achalasia are suboptimal along with the increased risk of gastroesophageal reflux disease (GERD). The impact of obesity on treatment success and GERD after peroral endoscopic myotomy (POEM) are not well known. Hence, our study aims were to compare the clinical outcomes and rates of GERD after POEM in nonobese versus obese patients with achalasia. Chart review of all achalasia patients who underwent POEM at our institution between April 2014 and June 2018. Patients with timed barium esophagram (TBE) and high-resolution esophageal manometry (HREM) before POEM along with post-POEM TBE, HREM, and esophageal pH study were included. Patients were categorized into 2 groups, nonobese (body mass index <30 kg/m) and obese (body mass index ≥30 kg/m). Patient demographics, TBE, HREM, pH study findings, and Eckardt scores were compared between the 2 groups. A total of 89 patients (46 nonobese; 43 obese) met the study criteria. There were no significant differences in age, gender, achalasia subtype, operative time, length of stay and complication rates between the 2 groups. Treatment success (Eckardt score ≤3) was similar in both groups (97.7% nonobese vs. 92.7% obese, P=0.35). Abnormal DeMeester scores on pH study (>14.72) were similar in nonobese and obese patients (58.7% vs. 46.5%, P=0.25). Symptomatic GERD was also similar in both groups (17.8% in nonobese vs. 20% in obese, P=0.79). POEM is an equally safe and effective treatment option for both nonobese and obese patients with achalasia in the short-term. Interestingly, POEM does not lead to higher rates of GERD in obese compared with nonobese patients.

Snare-tip-assisted peroral endoscopic myotomy for achalasia (with video).

Snare-tip-assisted peroral endoscopic myotomy for achalasia (with video).

Greater-curvature peroral endoscopic myotomy with diverticuloseptotomy for the treatment of achalasia in a patientwith a large epiphrenic diverticulum.

Greater-curvature peroral endoscopic myotomy with diverticuloseptotomy for the treatment of achalasia in a patientwith a large epiphrenic diverticulum.

Mo1997 - Per-Procedure Tridimentional High Resolution Esophageal Manometry During Peroral Endoscopic Myotomy for Achalasia

Mo1997 - Per-Procedure Tridimentional High Resolution Esophageal Manometry During Peroral Endoscopic Myotomy for Achalasia

Per-oral endoscopic myotomy in achalasia with large esophageal diverticulum: the “owl eyes” sign

Per-oral endoscopic myotomy in achalasia with large esophageal diverticulum: the “owl eyes” sign

The Clinical Research for the Selection Criteria of Surgical Method of Peroral Endoscopic Myotomy for Achalasia

The Clinical Research for the Selection Criteria of Surgical Method of Peroral Endoscopic Myotomy for Achalasia

Management of recurrent symptoms after per-oral endoscopic myotomy in achalasia

Per-oral endoscopic myotomy (POEM) has been rapidly gaining ground as a treatment for achalasia. Although POEM is a safe and effective treatment, a subset of patients has persistent or recurrent symptoms after POEM. This study aimed to examine the efficacy of different retreatments after failed POEM. POEM was performed on 441 patients with achalasia at 3 tertiary-care hospitals between 2010 and 2015. A review of prospectively collected data was conducted. All patients with achalasia with significant persistent or recurrent symptoms within 3 years after POEM, defined as an Eckardt symptom score >3, were included. Forty-three of 441 patients (9.8%) had persistent or recurrent symptoms after POEM, of which 34 (8%) received 1 or more retreatments. Retreatment with laparoscopic Heller myotomy and retreatment with POEM showed a modest efficacy of 45% and 63%, respectively, whereas pneumatic dilatation showed a poor efficacy of only 0% to 20%, depending on the size of the balloon. Male patients were more likely to have retreatment failure than female patients (P= .038). In patients with achalasia with persistent or recurrent symptoms after failed POEM, retreatment with laparoscopic Heller myotomy or retreatment with POEM has a higher efficacy than retreatment with pneumatic dilatations. Failure of retreatment occurred more often in male patients.

Tu1212 Per-Oral Endoscopic Myotomy for Achalasia, Esophagogastric Junction Outflow Obstruction and Diffuse Esophageal Spasm; A Us Tertiary Care Center Experience

Tu1212 Per-Oral Endoscopic Myotomy for Achalasia, Esophagogastric Junction Outflow Obstruction and Diffuse Esophageal Spasm; A Us Tertiary Care Center Experience

Controlled Study of Fully Covered Anti-Reflux Mental Stent and Peroral Endoscopic Myotomy for Achalasia

Controlled Study of Fully Covered Anti-Reflux Mental Stent and Peroral Endoscopic Myotomy for Achalasia

Peroral endoscopic myotomy for achalasia: an insight of current status (with video)

Peroral endoscopic myotomy for achalasia: an insight of current status (with video)

Causes and treatment of gas-related complications during peroral endoscopic myotomy for achalasia

Objective To investigate the causes and treatment of gas-related complications during peroral endoscopic myotomy(POEM) for achalasia(AC). Methods Retrospective analyses were performed on the clinical data of 390 AC patients receiving POEM at Chinese PLA General Hospital from December 2010 to July 2015.Univariate and multivariate analyses were conducted for potential risk factors and treatment for gas-related complications. Results Gas-related complications occurred in 55(14.10%, 55/390) cases.There were 4(1.03%, 4/390)cases of pneumothorax, 29(7.44%, 29/390)cases of pneumoperitoneum, 23(5.90%, 23/390)subcutaneous emphysema and 7(1.79%, 7/390) cardia avulsion during POEM. All gas-related complication were cured by conservative therapy, deflation by puncture or closed drainage of chest cavity.Univariate analysis revealed that tunnel length(χ2=6.209, P=0.045), myotomy depth(χ2=12.354, P=0.002), operation time(χ2=54.905, P=0.000)and previous therapies(χ2=16.920, P=0.000)were risk factors for gas-related complications. Multivariate analysis indicated that previous therapies(OR=4.150, 95%CI: 1.875-9.193), tunnel length(OR=2.410, 95%CI: 1.148-5.063), operation time(OR=4.750, 95%CI: 2.196-10.283)were risk factors for gas-related complications for AC during POEM. Conclusion Gas-related complications occurred frequently during POEM, especially for patients with previous therapies of AC. Tunnel length and operative time should be shortened as much as possible.Protective ventilation and CO2 pump should be employed during the whole POEM procedure. Mild complications, presented with merely a small amount of subcutaneous emphysema, do not require any special intervention. If severe pneumoperitoneum and pneumothorax occur, puncture should be applied immediately. Key words: Esophageal achalasia; Therapeutic Uses; Peroral endoscopic myotomy; Postoperative complications