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Original Article
- Timed barium esophagography to predict recurrent achalasia after peroral endoscopic myotomy: a retrospective study in Thailand
- Tharathorn Suwatthanarak, Chainarong Phalanusitthepa, Chatbadin Thongchuam, Thawatchai Akaraviputh, Vitoon Chinswangwatanakul, Thikhamporn Tawantanakorn, Somchai Leelakusolvong, Monthira Maneerattanaporn, Piyaporn Apisarnthanarak, Jitladda Wasinrat
- Clin Endosc 2024;57(5):610-619. Published online June 14, 2024
- DOI: https://doi.org/10.5946/ce.2023.236
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Graphical Abstract
Abstract
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PubReader
ePub - Background
/Aims: Achalasia is a rare esophageal motility disease, for which peroral endoscopic myotomy (POEM) has emerged as a promising treatment option; however, recurrence remains a challenge. Timed barium esophagography (TBE) is a useful diagnostic tool and potential outcome predictor of achalasia. This study aimed to determine predictive tools for recurrence after POEM.
Methods
This retrospective study enrolled achalasia patients who underwent POEM between January 2015 and December 2021. Patients were categorized into two groups using the 1-month post-POEM Eckardt scores and TBE: the discordant group (Eckardt score improved >50%, TBE decreased <50%) and the concordant group (both Eckardt score and TBE improved >50%). Recurrence was defined as a reincrease in the Eckardt score to more than three during follow-up.
Results
Complete medical records were available in 30 patients who underwent POEM. Seventeen patients (56.7%) were classified into the discordant group, while 13 patients (43.3%) were in the concordant group. The overall recurrence rate was 11.9% at 1-year, increasing to 23.8% during the extended follow-up. The discordant group had a 6.87 fold higher recurrence rate than the concordant group (52.9% vs. 7.7%, p=0.017).
Conclusions
These results strongly suggest that combining the Eckardt score with TBE can effectively predict recurrent achalasia after POEM. Patients in the discordant group had an elevated risk. -
Citations
Citations to this article as recorded by
- Assessment and Management of Reflux‐Related Esophageal Stricture After Peroral Endoscopic Myotomy in Achalasia
Shao‐Bin Luo, Zu‐Qiang Liu, Li Wang, Ming‐Yan Cai, Quan‐Lin Li, Ping‐Hong Zhou, Wei‐Feng Chen
Journal of Gastroenterology and Hepatology.2026; 41(1): 248. CrossRef - Never judge a book by its cover: the role of timed barium esophagography in patients with complete symptom relief after peroral endoscopic myotomy
Tae Hee Lee
Clinical Endoscopy.2024; 57(5): 604. CrossRef
- Assessment and Management of Reflux‐Related Esophageal Stricture After Peroral Endoscopic Myotomy in Achalasia
- 6,906 View
- 387 Download
- 2 Web of Science
- 2 Crossref
Reviews
- Role of endoscopy in patients with achalasia
- So Young Han, Young Hoon Youn
- Clin Endosc 2023;56(5):537-545. Published online June 2, 2023
- DOI: https://doi.org/10.5946/ce.2023.001
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Abstract
PDFPubReaderePub
- Achalasia is an esophageal motility disorder characterized by impaired lower esophageal sphincter relaxation and peristalsis of the esophageal body. With the increasing prevalence of achalasia, interest in the role of endoscopy in its diagnosis, treatment, and monitoring is also growing. The major diagnostic modalities for achalasia include high-resolution manometry, esophagogastroduodenoscopy, and barium esophagography. Endoscopic assessment is important for early diagnosis to rule out diseases that mimic achalasia symptoms, such as pseudo-achalasia, esophageal cancer, esophageal webs, and eosinophilic esophagitis. The major endoscopic characteristics suggestive of achalasia include a widened esophageal lumen and food residue in the esophagus. Once diagnosed, achalasia can be treated either endoscopically or surgically. The preference for endoscopic treatment is increasing owing to its minimal invasiveness. Botulinum toxins, pneumatic balloon dilation, and peroral endoscopic myotomy (POEM) are important endoscopic treatments. Previous studies have demonstrated excellent treatment outcomes for POEM, with >95% improvement in dysphagia, making POEM the mainstay treatment option for achalasia. Several studies have reported an increased risk of esophageal cancer in patients with achalasia. However, routine endoscopic surveillance remains controversial owing to the lack of sufficient data. Further studies on surveillance methods and duration are warranted to establish concordant guidelines for the endoscopic surveillance of achalasia.
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Citations
Citations to this article as recorded by- Saudi Gastroenterology Association (SGA) clinical care pathway and standards of care for peroral endoscopic myotomy (POEM) in achalasia
Resheed Alkhiari, Majid A. Almadi, Fahad Alsohaibani, Majid Alsahafi
Saudi Journal of Gastroenterology.2026; 32(1): 4. CrossRef - O papel da endoscopia no diagnóstico e tratamento de Acalasia
Rebeca Silva Moreira da Fraga, José Joaquim de Almeida Figueiredo, Thaisa de Moraes Ribeiro Espírito Santo, Esteban Sadovsky
Revista Brasileira de Pesquisa em Saúde/Brazilian Journal of Health Research.2025; 26(supl_3): 107. CrossRef - Effect of sex on the outcomes of peroral endoscopic myotomy for the treatment of achalasia
Chen-Yi Zhao, Ning Xu, Hao Dong, Ning-Li Chai, En-Qiang Linghu
World Journal of Gastroenterology.2025;[Epub] CrossRef - Postoperative Pain Management Strategies Following Peroral Endoscopic Myotomy (POEM): A Review
Jun Lu, Wentao Ji, Chao Sang, Zhi Wang, Lulong Bo
Journal of Pain Research.2025; Volume 18: 2761. CrossRef - Peroral endoscopic myotomy for achalasia combined with esophageal varices
Ah Young Lee, Joo Young Cho
Clinical Endoscopy.2025; 58(3): 490. CrossRef - Robotic Heller myotomy and fundoplication - techniques and outcomes
Daniel Scheese, Cody Tragesser, Tejal Patki, Carlos Puig, Rachit D. Shah
Mini-invasive Surgery.2025;[Epub] CrossRef - Antireflux mucosectomy for refractory gastroesophageal reflux disease following peroral endoscopic myotomy
Hideomi Tomida, Kazuhiro Tange, Yoshiou Ikeda, Yoichi Hiasa
Clinical Endoscopy.2025; 58(5): 766. CrossRef - Evaluation of Anesthesia Management During Peroral Endoscopic Myotomy in Patients with Achalasia: A Retrospective Study
Mukadder Sanli, Sami Akbulut, Muharrem Ucar, Yilmaz Bilgic
Journal of Clinical Medicine.2025; 14(18): 6504. CrossRef - Clinical Insights into Zenker’s Diverticulum: Anatomy, Pathophysiology, Diagnosis, and Evolving Treatments
Diego Panci, Francesco Carini, Riccardo Chiodo, Sabrina David, Francesco Cappello, Giovanni Tomasello
Anatomia.2025; 5(1): 1. CrossRef - A Novel Endoscopic Finding of Achalasia: “Endoscopic Vertebrae Sign”
Yorinari Ochiai, Yugo Suzuki, Kosuke Nomura, Hiroyuki Odagiri, Daisuke Kikuchi, Shu Hoteya
Digestion.2025; : 1. CrossRef - The role of cap-assisted endoscopy and its future implications
Sol Kim, Bo-In Lee
Clinical Endoscopy.2024; 57(3): 293. CrossRef - Never judge a book by its cover: the role of timed barium esophagography in patients with complete symptom relief after peroral endoscopic myotomy
Tae Hee Lee
Clinical Endoscopy.2024; 57(5): 604. CrossRef - Advanced Esophageal Endoscopy
Kyoungwon Jung, Rebecca M. Haug, Andrew Y. Wang
Gastroenterology Clinics of North America.2024; 53(4): 603. CrossRef - Case of Concomitant Endoscopic Treatment of Achalasia with Superficial Esophageal Cancer
Myung-Hun Lee, Kyoungwon Jung, Jae Hyun Kim, Sung Eun Kim, Won Moon, Moo In Park, Seun Ja Park
The Korean Journal of Gastroenterology.2023; 82(5): 248. CrossRef
- Saudi Gastroenterology Association (SGA) clinical care pathway and standards of care for peroral endoscopic myotomy (POEM) in achalasia
- 14,902 View
- 543 Download
- 12 Web of Science
- 14 Crossref
- Submucosal endoscopy: the present and future
- Zaheer Nabi, Duvvur Nageshwar Reddy
- Clin Endosc 2023;56(1):23-37. Published online January 9, 2023
- DOI: https://doi.org/10.5946/ce.2022.139
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Abstract
PDFPubReaderePub
- Submucosal endoscopy or third-space endoscopy utilizes the potential space between the mucosal and muscularis layers of the gastrointestinal tract to execute therapeutic interventions for various diseases. Over the last decade, endoscopic access to the submucosal space has revolutionized the field of therapeutic endoscopy. Submucosal endoscopy was originally used to perform endoscopic myotomy in patients with achalasia cardia, and its use has grown exponentially since. Currently, submucosal endoscopy is widely used to resect subepithelial tumors and to manage refractory gastroparesis and Zenker’s diverticulum. While the utility of submucosal endoscopy has stood the test of time in esophageal motility disorders and subepithelial tumors, its durability remains to be established in conditions such as Zenker’s diverticulum and refractory gastroparesis. Other emerging indications for submucosal endoscopy include esophageal epiphrenic diverticulum, Hirschsprung’s disease, and esophageal strictures not amenable to conventional endoscopic treatment. The potential of submucosal endoscopy to provide easy and safe access to the mediastinum and peritoneal spaces may open doors to novel indications and rejuvenate the interest of endoscopists in natural orifice transluminal endoscopic surgery in the future. This review focuses on the current spectrum, recent updates, and future direction of submucosal endoscopy in the gastrointestinal tract.
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Citations
Citations to this article as recorded by- Natural orifice transluminal endoscopic surgery: history and current development
Zaheer Nabi, D. Nageshwar Reddy
Clinical Endoscopy.2026; 59(1): 21. CrossRef - Advancements in endoscopic resection of subepithelial tumors: toward safer, recurrence-free techniques
Won Shik Kim, Moon Kyung Joo
Clinical Endoscopy.2025; 58(2): 256. CrossRef - Peroral endoscopic myotomy for achalasia combined with esophageal varices
Ah Young Lee, Joo Young Cho
Clinical Endoscopy.2025; 58(3): 490. CrossRef - Comments on 'Flexible endoscopic treatment of Zenker’s diverticulum: a retrospective study in a single center from Turkey'
Hye Kyung Jeon, Gwang Ha Kim
Clinical Endoscopy.2025; 58(3): 488. CrossRef - A review of techniques of third space endoscopy for gastrointestinal tumors
Zaheer Nabi, D. Nageshwar Reddy
Current Opinion in Gastroenterology.2025; 41(5): 327. CrossRef - Mapping global trends and research frontiers in third-space endoscopy: A visual and bibliometric analysis
Alp Omer Canturk, Adem Senturk
Medicine.2025; 104(34): e44059. CrossRef - Per-rectal endoscopic myotomy for ultrashort-segment Hirschsprung’s disease in adult patients
Harshal Surendra Mandavdhare, Arvind Sekar, Ritesh Acharya, Rajani Kant Kumar
Clinical Endoscopy.2025; 58(5): 770. CrossRef - Emerging indications for third space endoscopy
Rahil H. Shah, Sunil Amin
Best Practice & Research Clinical Gastroenterology.2024; 71: 101911. CrossRef - Therapeutic endoscopy: Recent updates and future directions
Zaheer Nabi, D. Nageshwar Reddy
Digestive and Liver Disease.2024; 56(11): 1810. CrossRef - Endoscopic full thickness resection: techniques, applications, outcomes
Zaheer Nabi, D. Nageshwar Reddy
Expert Review of Gastroenterology & Hepatology.2024; 18(6): 257. CrossRef - The role of cap-assisted endoscopy and its future implications
Sol Kim, Bo-In Lee
Clinical Endoscopy.2024; 57(3): 293. CrossRef - Precision Endoscopy in Peroral Myotomies for Motility Disorders of the Upper Gastrointestinal Tract: Current Insights and Prospective Avenues—A Comprehensive Review
Francesco Vito Mandarino, Edoardo Vespa, Alberto Barchi, Ernesto Fasulo, Emanuele Sinagra, Francesco Azzolini, Silvio Danese
Life.2023; 13(11): 2143. CrossRef - An Esophageal Leiomyoma with Cystic Degeneration Mimicking a Malignant Neoplasm
Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
The Ewha Medical Journal.2023;[Epub] CrossRef - Prevalence, natural progression, and clinical practices of upper gastrointestinal subepithelial lesions in Korea: a multicenter study
Younghee Choe, Yu Kyung Cho, Gwang Ha Kim, Jun-Ho Choi, Eun Soo Kim, Ji Hyun Kim, Eun Kwang Choi, Tae Hyeon Kim, Seong-Hun Kim, Do Hoon Kim
Clinical Endoscopy.2023; 56(6): 744. CrossRef
- Natural orifice transluminal endoscopic surgery: history and current development
- 7,054 View
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- 15 Web of Science
- 14 Crossref
Original Article
- The Learning Curve for Peroral Endoscopic Myotomy in Latin America: A Slide to the Right?
- Michel Kahaleh, Amy Tyberg, Supriya Suresh, Arnon Lambroza, Fernando Rodriguez Casas, Mario Rey, Jose Nieto, Guadalupe Ma Martínez, Felipe Zamarripa, Vitor Arantes, Maria G Porfilio, Monica Gaidhane, Pietro Familiari, Juan Carlos Carames, Romulo Vargas-Rubio, Raul Canadas, Albis Hani, Guillermo Munoz, Bismarck Castillo, Eduardo T Moura, Farias F Galileu, Hannah P Lukashok, Carlos Robles-Medranda, Eduardo G de Moura
- Clin Endosc 2021;54(5):701-705. Published online June 3, 2021
- DOI: https://doi.org/10.5946/ce.2020.290
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Abstract
PDFPubReaderePub
- Background
/Aims: Peroral endoscopic myotomy (POEM) has been increasingly used for achalasia in Latin America, where Chagas disease is prevalent, and this makes POEM more challenging. The aim of this study was to determine the learning curve for POEM in Latin America.
Methods
Patients undergoing POEM in Latin America with a single operator were included from a prospective registry over 4 years. Non-linear regression and cumulative sum control chart (CUSUM) analyses were conducted for the learning curve.
Results
A total of 125 patients were included (52% male; mean age, 59 years), of which 80 had type II achalasia (64%), and 38 had Chagas disease (30%). The average pre-procedure and post-procedure Eckardt scores were 6.79 and 1.87, respectively. Technical success was achieved in 93.5% of patients, and clinical success was achieved in 88.8%. Adverse events occurred in 27 patients (22%) and included bleeding (4 patients), pneumothorax (4 patients), mucosal perforation (13 patients), mediastinitis (2 patients), and leakage (4 patients).
The CUSUM chart showed a median procedure time of 97 min (range, 45-196 min), which was achieved at the 61st procedure. Procedure duration progressively decreased, with the last 10 procedures under 50 min approaching a plateau (p-value <0.01).
Conclusions
Mastering POEM in Latin America requires approximately 61 procedures for both POEM efficiency and to accomplish the procedure within 97 minutes. -
Citations
Citations to this article as recorded by- Retrospective cohort study of launching a new peroral pyloromyotomy practice—A framework for introducing endoscopic surgery within a hospital system
Seung Hyeon Shim, Kevin El-Hayek, Jennifer Colvin
Surgery.2026; 191: 109905. CrossRef - Miotomía endoscópica por vía oral (POEM) como tratamiento para la acalasia pediátrica: estudio multicéntrico y primeros resultados
Carlos Leganés Villanueva, Eduardo Albéniz Arbizu, Ilaria Goruppi, Nuria Brun Lozano, Federica Bianchi, Alberto Pérez Martínez, Sheyla Montori Pina, Ada Yessenia Molina Caballero, Marianette Murzi, Federico Betroletti, Fermin Estremera, Susana Boronat Gue
Gastroenterología y Hepatología.2025; 48(4): 502262. CrossRef - Peroral endoscopic myotomy (POEM) as a treatment for pediatric achalasia: Multicenter study and first results
Carlos Leganés Villanueva, Eduardo Albéniz Arbizu, Ilaria Goruppi, Nuria Brun Lozano, Federica Bianchi, Alberto Pérez Martínez, Sheyla Montori Pina, Ada Yessenia Molina Caballero, Marianette Murzi, Federico Betroletti, Fermin Estremera, Susana Boronat Gue
Gastroenterología y Hepatología (English Edition).2025; 48(4): 502262. CrossRef - Curriculum for training in peroral endoscopic myotomy (POEM) in Europe (Part I): European Society of Gastrointestinal Endoscopy (ESGE) Position Statement
Enrique Rodríguez de Santiago, David J. Tate, João Santos-Antunes, Sandra Nagl, Zuzana Vacková, Marcel Tantau, Isis K. Araujo, Eduardo Guimarães Hourneaux de Moura, Pietro Familiari, Helmut Messmann, Alanna Ebigbo, Paul Fockens, Raf Bisschops, Henriette H
Endoscopy.2025; 57(07): 778. CrossRef - Management Strategies for Zenker’s Diverticulum: A Comprehensive Review
Suhaas Ramamurthy, Priyanka Ahuja, Dushyant Singh Dahiya, Umar Hayat, Neha Ahuja, Hareesha Rishab Bharadwaj, Manesh Kumar Gangwani, Sumant Inamdar
Journal of Clinical Medicine.2025; 14(17): 6141. CrossRef - Proficiency in Esophageal Peroral Endoscopic Myotomy
Yizhong Wu, Alexander Grieme, Manuel Garza, Erica Yatsynovich, Erik Rahimi, Azizullah Beran, Marco Spadaccini, Lumir Kunovsky, Daryl Ramai
Journal of Clinical Gastroenterology.2025;[Epub] CrossRef - Experiencia en miotomía endoscópica peroral en un centro de Bogotá, Colombia, entre 2018 y 2022
Tatiana P Barragan Briceño, Paola Stephany Gonzalez Ausique, Carlos Fernando Fuentes Díaz, Jesús Antonio Rodríguez Fajardo, Maria Camila Gomez Ayala
Revista colombiana de Gastroenterología.2024; 39(2): 146. CrossRef - Learning curve for esophageal peroral endoscopic myotomy: a systematic review and meta-analysis
Srinivas R. Puli, Mihir S. Wagh, David Forcione, Harishankar Gopakumar
Endoscopy.2023; 55(04): 355. CrossRef - Diagnosis and Management of Achalasia: Updates of the Last Two Years
Amir Mari, Fadi Abu Baker, Rinaldo Pellicano, Tawfik Khoury
Journal of Clinical Medicine.2021; 10(16): 3607. CrossRef - Issues to be Considered for Learning Curve for Peroral Endoscopic Myotomy
Hironari Shiwaku, Haruhiro Inoue
Clinical Endoscopy.2021; 54(5): 625. CrossRef
- Retrospective cohort study of launching a new peroral pyloromyotomy practice—A framework for introducing endoscopic surgery within a hospital system
- 6,479 View
- 100 Download
- 8 Web of Science
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Focused Review Series: Cutting Edge of Advanced Therapeutic Endoscopy
- Peroral Endoscopic Myotomy for Esophageal Motility Disorders
- Jun Young Kim, Yang Won Min
- Clin Endosc 2020;53(6):638-645. Published online November 20, 2020
- DOI: https://doi.org/10.5946/ce.2020.223
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Abstract
PDFPubReaderePub
- Peroral endoscopic myotomy (POEM) is one of the most clinically successful tunnel-based minimally invasive endoscopic treatments. The classic indications of POEM include achalasia of all types, including failed prior treatments, and expanded indications include the non-achalasia esophageal motility disorders, such as esophagogastric junction outflow obstruction, diffuse esophageal spasm, and jackhammer esophagus. For achalasia treatment, POEM has achieved a comparable surgical efficacy and a safety outcome and, therefore, has emerged as a first-line treatment. For non-achalasia esophageal motility disorders, POEM has also shown high clinical response rates. The complication rate of POEM for esophageal motility disorders is low and most complications are managed with conservative treatment. Currently, POEM is a representative procedure of natural orifice transluminal endoscopic surgery, which has shown a good clinical efficacy with low complication rates for esophageal motility disorders including achalasia. However, further studies are needed to treat non-achalasia motility disorder via POEM.
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Citations
Citations to this article as recorded by- Intraoperative Complications During Benign Esophageal Surgery
Katelyn R. Ward, Jenny Bui, Rishindra M. Reddy
Thoracic Surgery Clinics.2025; 35(3): 329. CrossRef - Evaluation of Anesthesia Management During Peroral Endoscopic Myotomy in Patients with Achalasia: A Retrospective Study
Mukadder Sanli, Sami Akbulut, Muharrem Ucar, Yilmaz Bilgic
Journal of Clinical Medicine.2025; 14(18): 6504. CrossRef - Peroral endoscopic myotomy as an effective and safe treatment for achalasia: The authors’ experience and a literature review
Wojciech Ciesielski, Tomasz Klimczak, Izabela Kempska, Martyna Waszczyk, Aleksandra Osielczak, Adam Durczyński, Janusz Strzelczyk, Jarosław Buczyński, Piotr Hogendorf
International Journal of Gastrointestinal Intervention.2025; 14(4): 197. CrossRef - Diffuse Esophageal Spasm: An Alternative Treatment Approach
McKenzie K Allen , Wayne Frei
Cureus.2024;[Epub] CrossRef - Imaging following endoscopic and surgical treatment of achalasia
Kristina T. Flicek, Laura R. Carucci, Mary Ann Turner
Abdominal Radiology.2024; 50(5): 1942. CrossRef - Diagnostics and Treatment of Esophageal Achalasia (Clinical Guidelines of the Russian Gastroenterological Association, Russian Scientific Medical Society of Internal Medicine, Russian Society for the Prevention of Noncommunicable Diseases, REndO Endoscopi
V. T. Ivashkin, A. S. Trukhmanov, I. V. Maev, O. M. Drapkina, A. I. Martynov, O. A. Storonova, E. A. Godgello, M. P. Korolev, T. L. Lapina, P. V. Pavlov, A. V. Paraskevova, I. A. Tarasova, E. D. Fedorov, A. T. Tskhovrebov, M. P. Shapka, A. L. Shestakov, A
Russian Journal of Gastroenterology, Hepatology, Coloproctology.2024; 34(6): 120. CrossRef - Clinical and financial outcomes of per-oral endoscopic myotomy compared to laparoscopic heller myotomy for treatment of achalasia
Lena Shally, Kashif Saeed, Derek Berglund, Mark Dudash, Katie Frank, Vladan N. Obradovic, Anthony T. Petrick, David L. Diehl, Jon D. Gabrielsen, David M. Parker
Surgical Endoscopy.2023; 37(7): 5526. CrossRef - Benefit of extending the protocol for high resolution manometry according to the version 4.0 of the Chicago criteria. A multicenter study
Luis G. Alcalá‐González, Alberto Ezquerra‐Duran, Ariadna Aguilar, Claudia Barber, Elizabeth Barba, Isis K. Araujo, Ingrid Marin, Juan Naves, Jordi Serra
Neurogastroenterology & Motility.2023;[Epub] CrossRef - Role of Endoscopy in Motility Disorders of Upper Gastrointestinal Tract
Jin Hee Noh, Hwoon-Yong Jung
Journal of Neurogastroenterology and Motility.2023; 29(1): 7. CrossRef - Surveillance Endoscopy After Foregut Surgery: Is It Necessary?
Yahya Alwatari, Daniel Scheese, Graham Gardner, Vignesh Vudatha, Walker Julliard, Carlos Puig Gilbert, Rachit D. Shah
Foregut: The Journal of the American Foregut Society.2023; 3(1): 89. CrossRef - Per oral endoscopic myotomy for achalasia: A Taiwanese single‐center experience
Yu‐Chi Lee, Wei‐Chen Tai, Keng‐Liang Wu, Chih‐Chien Yao, Seng‐Kee Chuah
Advances in Digestive Medicine.2022; 9(4): 241. CrossRef - Pediatric anesthesia and achalasia: 10 years’ experience in peroral endoscopy myotomy management
Fabio Sbaraglia, Pietro Familiari, Federica Maiellare, Marco Mecarello, Annamaria Scarano, Demetrio Del Prete, Rosa Lamacchia, Federica Antonicelli, Marco Rossi
Journal of Anesthesia, Analgesia and Critical Care.2022;[Epub] CrossRef - A rare complication: Tension pneumothorax after peroral endoscopic myotomy
Seokin Kang, Yuri Kim, Do Hoon Kim
International Journal of Gastrointestinal Intervention.2022; 11(3): 139. CrossRef - Endoscopic Management of Dysphagia
Min Ji Kim, Yang Won Min
The Korean Journal of Gastroenterology.2021; 77(2): 77. CrossRef - An update on endoscopic treatment for achalasia: From per oral endoscopic myotomy to endolumenal functional lumen imaging probe
Wei‐Chen Tai, Keng‐Liang Wu, Seng‐Kee Chuah
Advances in Digestive Medicine.2021; 8(1): 8. CrossRef
- Intraoperative Complications During Benign Esophageal Surgery
- 7,745 View
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Original Article
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Determining the Safety and Effectiveness of Electrocautery Enhanced Scissors for Peroral Endoscopic Myotomy (with Video)
- Kelly E. Hathorn, Walter W. Chan, Hiroyuki Aihara, Christopher C. Thompson
- Clin Endosc 2020;53(4):443-451. Published online May 22, 2020
- DOI: https://doi.org/10.5946/ce.2019.214
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Abstract
PDF
Supplementary MaterialPubReaderePub - Background
/Aims: Peroral endoscopic myotomy (POEM) has recently come to the forefront in the management of achalasia. We aimed to analyze the efficacy and safety of the use of electrocautery enhanced scissors (EES) for POEM.
Methods
This retrospective cohort study prospectively collected the data of all adult patients (aged ≥18 years) with normal foregut anatomy who underwent POEM using EES. The patients’ baseline characteristics and procedure details (time, tunnel length, myotomy length, depth, and location) were recorded. The primary outcome was clinical success (3-month post-procedure Eckardt score of ≤3). The secondary outcomes were technical success and adverse events. A paired Student’s t-test was performed.
Results
Fifteen patients were included in this study. The technical success rate of myotomy using EES was 100%. Fellows participated in the myotomy in all cases. The clinical success rate was 93.3% (14/15). The mean pre-Eckardt score was 5.4±2.5, while the mean post-Eckardt score was 1.3±1.3, which indicated a significant improvement (p≤0.0001). The most common treatment-related adverse events were post-procedure pain (4, 26.7%) and symptomatic reflux disease (4, 26.7%).
Conclusions
In the largest series to date on the use of EES in POEM, we demonstrated that this technique has both technical and clinical efficacy as well as an excellent safety profile. -
Citations
Citations to this article as recorded by- Curriculum for training in peroral endoscopic myotomy (POEM) in Europe (Part II) – Best Practice Techniques: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement
David J. Tate, Enrique Rodriguez de Santiago, Michele Montori, Vikash Lala, Lynn K. Debels, Eduardo Albéniz, Isis K. Araujo, Eduardo Guimarães Hourneaux de Moura, Alanna Ebigbo, Pietro Familiari, Paul Fockens, Henriette Heinrich, Oleksandr Kiosov, Helmut
Endoscopy.2025; 57(08): 912. CrossRef - Peroral endoscopic myotomy using an endoscopic dissector: another novel device in our toolbox
Shruti Mony, Apurva Shrigiriwar, Andrew Canakis, Mouen A. Khashab
VideoGIE.2023; 8(1): 5. CrossRef - Peroral endoscopic myotomy (POEM) is more cost-effective than laparoscopic Heller myotomy in the short term for achalasia: economic evaluation from a randomized controlled trial
Tatiana Morgado Conte, Luciana Bertocco de Paiva Haddad, Igor Braga Ribeiro, Eduardo Turiani Hourneaux de Moura, Luiz Augusto Carneiro DʼAlbuquerque, Eduardo Guimarães Hourneaux de Moura
Endoscopy International Open.2020; 08(11): E1673. CrossRef
- Curriculum for training in peroral endoscopic myotomy (POEM) in Europe (Part II) – Best Practice Techniques: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement
- 7,787 View
- 87 Download
- 3 Web of Science
- 3 Crossref
Case Report
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Hybrid Peroral Endoscopic Myotomy for Achalasia with Prior Treatment Failure
- In Kyung Yoo, Abdullah OzgurYeniova, Joo Young Cho
- Clin Endosc 2021;54(1):127-130. Published online April 2, 2020
- DOI: https://doi.org/10.5946/ce.2020.013
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Abstract
PDFSupplementary MaterialPubReaderePub
- Achalasia is a neurodegenerative motility disorder caused by enteric neuron damage in the lower esophageal sphincter. Peroral endoscopic myotomy (POEM) is a standard treatment method for achalasia. Previous treatment modalities may affect the outcome of POEM as they cause submucosal fibrosis. We report a new technique called “hybrid POEM” for the treatment of patients with achalasia who had been previously treated with pneumatic balloon dilatation. We performed two techniques of POEM simultaneously, the standard POEM for the upper part of the submucosal tunnel and open POEM for the stenotic part of the esophagogastric junction. We dissected the mucosa and submucosa, and performed myotomy simultaneously. We overcame submucosal fibrosis of the esophagogastric junction, which was caused by the previous hybrid POEM treatment. The risks of mucosal incision and technical challenge of submucosal tunneling for the fibrotic area may be reduced by hybrid POEM.
- 5,781 View
- 165 Download
Original Article
- Experience with Peroral Endoscopic Myotomy for Achalasia and Spastic Esophageal Motility Disorders at a Tertiary U.S. Center
- Maen Masadeh, Peter Nau, Subhash Chandra, Jagpal Klair, John Keech, Kalpaj Parekh, Rami El Abiad, Henning Gerke
- Clin Endosc 2020;53(3):321-327. Published online November 20, 2019
- DOI: https://doi.org/10.5946/ce.2019.110
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Abstract
PDFPubReaderePub
- Background
/Aims: Peroral endoscopic myotomy (POEM) is a novel procedure for the treatment of achalasia and spastic esophageal disorders. Experience with POEM is limited, but its reported outcomes are excellent. It is deemed safe even for patients with prior interventions.
Methods
This retrospective review included patients who underwent POEM at a tertiary US center. POEM was performed in a multidisciplinary approach by advanced endoscopists and foregut surgeons. Clinical success was defined as a post-POEM Eckardt score ≤3.
Results
A total of 125 patients were included. Median follow-up period was 18 months (interquartile range, 10–22 months). Clinical success was achieved in 92% of patients and persisted at 12 months in 88% of patients. Mucosal barrier failure (MBF) occurred in 7 patients, 2 of whom required surgical intervention. MBF was more common in patients with prior laparoscopic Heller myotomy (19% vs. 3%, p=0.015). MBF requiring surgical intervention occurred early in the learning curve.
Conclusions
POEM is safe and effective in the treatment of achalasia and spastic esophageal disorders even after failed prior interventions. -
Citations
Citations to this article as recorded by- Comparing clinical outcomes of peroral endoscopic myotomy for achalasia between Eastern and Western countries: a systematic review and meta-analysis
Han Zhang, Xinxin Pu, Shu Huang, Huifang Xia, Kang Zou, Xinyi Zeng, Jiao Jiang, Wensen Ren, Yan Peng, Muhan Lü, Xiaowei Tang
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Zaheer Nabi, Radhika Chavan, Mohan Ramchandani, Jahangeer Basha, Nitin Jagtap, Arun Karyampudi, Santosh Darisetty, Manu Tandan, Rajesh Goud, Guduru Venkat Rao, Duvvur Nageshwar Reddy
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S Bomman, J S Klair, M Ashat, R El Abiad, H Gerke, J Keech, K Parekh, P Nau, Y Hanada, L M Wong Kee Song, R Kozarek, S Irani, D Low, A Ross, R Krishnamoorthi
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Young Hoon Youn
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- Comparing clinical outcomes of peroral endoscopic myotomy for achalasia between Eastern and Western countries: a systematic review and meta-analysis
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Case Report
-
Two-Stage Peroral Endoscopic Myotomy for Sigmoid-Type Achalasia
- Hak Su Kim, Hee Kyung Kim, Weon Jin Ko
- Clin Endosc 2020;53(2):232-235. Published online July 16, 2019
- DOI: https://doi.org/10.5946/ce.2019.067
-
Abstract
PDFSupplementary MaterialPubReaderePub
- Peroral endoscopic myotomy (POEM) has been recently considered as the first treatment option for achalasia. The standard POEM procedures are often successful in most patients, but sometimes technical challenges are encountered. We report a new technique that is divided between two tunneling sites in the esophagus for sigmoid-type achalasia. A 40-year-old male patient with dysphagia for 10 years was diagnosed with a sigmoid-shaped esophagus at our hospital. We devised a two-stage myotomy technique to treat sigmoidtype achalasia. The myotomy was first performed in the upper part of the greater flexion area and then in the lower part of the flexion. We termed this method “two-stage POEM”, which was successfully performed without any complications. This new POEM method can also be used to improve symptoms in patients with achalasia who have a structural deformity that may result in a high change of treatment failure.
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Citations
Citations to this article as recorded by- Multiple submucosal tunneling endoscopic myotomies to address angulation in advanced sigmoid-type achalasia
Jing-Zheng Liu, Li-Na Fan, Ping-Hong Zhou
Gastroenterology Report.2026;[Epub] CrossRef
- Multiple submucosal tunneling endoscopic myotomies to address angulation in advanced sigmoid-type achalasia
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Original Article
- Retention Esophagitis as a Significant Clinical Predictor of Progression to Esophageal Cancer in Achalasia
- Haewon Kim, Hyojin Park, HeeSeung Choi, Yooju Shin, Hyunsung Park, Young Hoon Youn, Jie-Hyun Kim
- Clin Endosc 2018;51(2):161-166. Published online March 6, 2018
- DOI: https://doi.org/10.5946/ce.2017.087
-
Abstract
PDFSupplementary MaterialPubReaderePub
- Background
/Aims: Chronic liquid and/or food stasis caused by retention esophagitis (RE) in achalasia is a notable endoscopic finding because of the presence of a thickened or whitish esophageal mucosa and histologically altered squamous hyperplasia. We aimed to identify the clinical features of RE associated with achalasia and to clarify the clinical definition of RE in achalasia as a precancerous lesion identified by analyzing biomarker expressions.
Methods
From 2006 to 2015, we retrospectively reviewed 37 patients with achalasia without previous treatment. Among them, 21 patients had diagnostic findings of RE (RE+) and 16 patients had no diagnostic findings of RE (RE–). Immunohistochemical staining of p53, p16, and Ki-67 was performed on the endoscopic biopsy tissues from the patients with achalasia and 10 control patients with non-obstructive dysphagia.
Results
The symptom duration and transit delay were significantly longer in the RE+ group than in the RE– group. We found particularly high p53 positivity rates in the RE+ group (p<0.001). The rate of p16 expression was also significantly higher in the RE+ group than in the other two groups (p=0.003).
Conclusions
A high p53 expression rate was more frequently found in the RE+ group than in the other two groups. RE could be a meaningful clinical feature of achalasia for predicting esophageal carcinogenesis. -
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Focused Review Series: The New Era of Therapeutic Endoscopy - Endoscopic Submucosal Surgery
- Current Status of Peroral Endoscopic Myotomy
- Young Kwan Cho, Seong Hwan Kim
- Clin Endosc 2018;51(1):13-18. Published online January 31, 2018
- DOI: https://doi.org/10.5946/ce.2017.165
-
Abstract
PDFPubReaderePub
- Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders.
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Citations
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Focused Review Series: Endoscopy in Children
- Advanced Therapeutic Gastrointestinal Endoscopy in Children – Today and Tomorrow
- Zaheer Nabi, Duvvur Nageshwar Reddy
- Clin Endosc 2018;51(2):142-149. Published online December 12, 2017
- DOI: https://doi.org/10.5946/ce.2017.102
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Abstract
PDFPubReaderePub
- Gastrointestinal (GI) endoscopy plays an indispensable role in the diagnosis and management of various pediatric GI disorders. While the pace of development of pediatric GI endoscopy has increased over the years, it remains sluggish compared to the advancements in GI endoscopic interventions available in adults. The predominant reasons that explain this observation include lack of formal training courses in advanced pediatric GI interventions, economic constraints in establishing a pediatric endoscopy unit, and unavailability of pediatric-specific devices and accessories. However, the situation is changing and more pediatric GI specialists are now performing complex GI procedures such as endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography for various pancreatico-biliary diseases and more recently, per-oral endoscopic myotomy for achalasia cardia. Endoscopic procedures are associated with reduced morbidity and mortality compared to open surgery for GI disorders. Notable examples include chronic pancreatitis, pancreatic fluid collections, various biliary diseases, and achalasia cardia for which previously open surgery was the treatment modality of choice. A solid body of evidence supports the safety and efficacy of endoscopic management in adults. However, additions continue to be made to literature describing the pediatric population. An important consideration in children includes size of children, which in turn determines the selection of endoscopes and type of sedation that can be used for the procedure.
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Citations
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Case Reports
- Double-Scope Peroral Endoscopic Myotomy (POEM) for Esophageal Achalasia: The First Trial of a New Double-Scope POEM
- Hee Jin Hong, Ga Won Song, Weon Jin Ko, Won Hee Kim, Ki Baik Hahm, Sung Pyo Hong, Joo Young Cho
- Clin Endosc 2016;49(4):383-386. Published online March 15, 2016
- DOI: https://doi.org/10.5946/ce.2015.108
-
Abstract
PDFPubReaderePub
- With the accumulation of clinical trials demonstrating its efficacy and safety, peroral endoscopic myotomy (POEM) has emerged as a less invasive treatment option for esophageal achalasia compared with laparoscopic Heller myotomy. However, the difficulty in determining the exact extent of myotomy, a critical factor associated with the success and safety of the procedure, remains a limitation. Although the various endoscopic landmarks and ancillary techniques have been applied, none of these has been proven sufficient. As a solution for this limitation, the double-scope POEM technique with a second endoscope to assure the exact length of the submucosal tunnel has been applied since 2014. Before double-scope POEM was introduced, the second endoscope was applied only to confirm the accuracy of the procedure. In the present study, we performed double-scope POEM in the treatment of esophageal achalasia through a novel procedure of simultaneous application of the second endoscope to assist in the conventional POEM procedure.
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Citations
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Shinwa Tanaka, Fumiaki Kawara, Takashi Toyonaga, Haruhiro Inoue, Robert Bechara, Namiko Hoshi, Hirohumi Abe, Yoshiko Ohara, Tsukasa Ishida, Yoshinori Morita, Eiji Umegaki
Digestive Endoscopy.2018; 30(2): 206. CrossRef
- Per-oral endoscopic myotomy (POEM) in achalasia: why length matters
- 10,249 View
- 117 Download
- 12 Web of Science
- 12 Crossref
- Extragastroesophageal Malignancy-Associated Secondary Achalasia: A Rare Association of Pancreatic Cancer Rendering Alarm Manifestation
- Hong Min Kim, Ji Min Chu, Won Hee Kim, Sung Pyo Hong, Ki Baik Hahm, Kwang Hyun Ko
- Clin Endosc 2015;48(4):328-331. Published online July 24, 2015
- DOI: https://doi.org/10.5946/ce.2015.48.4.328
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Abstract
PDFPubReaderePub
Secondary achalasia or pseudoachalasia is a rare esophageal motor abnormality, which mimics primary achalasia; it is not easily distinguishable from idiopathic achalasia by manometry, radiological examination, or endoscopy. Although the majority of reported pseudoachalasia cases are associated with neoplasms at or near the esophagogastric (EG) junction, other neoplastic processes or even chronic illnesses such as rheumatoid arthritis can lead to the development of pseudoachalasia, for example, mediastinal masses, gastrointestinal (GI) tumors of the liver and biliary tract, and non-GI malignancies. Therefore, even if a patient presents with the typical findings of achalasia, we should be alert to the possibility of other GI malignancies besides EG tumors. For instance, pancreatic cancer was found in the case reported here; only four such cases have been reported in the literature. A 47-year-old man was admitted to our center with a 3-month history of dysphagia. His endoscopic and esophageal manometric findings were compatible with primary achalasia. However, unresponsiveness to diverse conventional achalasia treatments led us to suspect secondary achalasia. An active search led to a diagnosis of pancreatic mucinous cystadenocarcinoma invading the gastric fundus and EG junction. This rare case of pseudoachalasia caused by pancreatic carcinoma emphasizes the need for suspecting GI malignancies other than EG tumors in patients refractory to conventional achalasia treatment.
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Citations
Citations to this article as recorded by- Delayed Presentation of Malignancy-Associated Pseudoachalasia of the Gastric Cardia
Clive J Miranda, Farhan Azad, Ross R Moyer, Sasikanth N Ravi, Gina M Sparacino
Cureus.2024;[Epub] CrossRef - Is it necessary to perform a morphological assessment for an esophageal motility disorder? A retrospective descriptive study
Sofya Latrache, Chloe Melchior, Charlotte Desprez, Sabrina Sidali, Julien Recton, Olivier Touchais, Elise van der Eecken, Fabien Wuestenberghs, Cloe Charpentier, Anne Marie Leroi, Guillaume Gourcerol
Clinics and Research in Hepatology and Gastroenterology.2021; 45(6): 101633. CrossRef - When a Late Metastasis Is Hard to Swallow
Catarina Negrão, Rita Sismeiro, Margarida Monteiro, Filipa G Pereira, Marta Jonet
Cureus.2021;[Epub] CrossRef - Development of pseudoachalasia following magnetic sphincter augmentation (MSA) with restoration of peristalsis after endoscopic dilation
Katrin Schwameis, Shahin Ayazi, Ali H. Zaidi, Toshitaka Hoppo, Blair A. Jobe
Clinical Journal of Gastroenterology.2020; 13(5): 697. CrossRef - Burkitt’s Lymphoma of the Gastrohepatic Omentum: A Malignant Presentation of Pseudoachalasia
Eric Omar Then, Andrew Ofosu, Prashanth Rawla, Tagore Sunkara, Sriharsha Dadana, Andrea Culliford, Vinaya Gaduputi
Case Reports in Gastrointestinal Medicine.2019; 2019: 1. CrossRef
- Delayed Presentation of Malignancy-Associated Pseudoachalasia of the Gastric Cardia
- 9,557 View
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- 6 Web of Science
- 5 Crossref
- Esophageal Cancer in Esophageal Diverticula Associated with Achalasia
- Ah Ran Choi, Nu Ri Chon, Young Hoon Youn, Hyo Chae Paik, Yon Hee Kim, Hyojin Park
- Clin Endosc 2015;48(1):70-73. Published online January 31, 2015
- DOI: https://doi.org/10.5946/ce.2015.48.1.70
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Abstract
PDFPubReaderePub
The simultaneous occurrence of achalasia and esophageal diverticula is rare. Here, we report the case of a 68-year-old man with multiple esophageal diverticula associated with achalasia who was later diagnosed with early esophageal cancer. He initially presented with dysphagia and dyspepsia, and injection of botulinum toxin to the lower esophageal sphincter relieved his symptoms. Five years later, however, the patient presented with worsening of symptoms, and esophagogastroduodenoscopy (EGD) was performed. The endoscopic findings showed multifocal lugol-voiding lesions identified as moderate dysplasia. We decided to use photodynamic therapy to treat the multifocal dysplastic lesions. At follow-up EGD 2 months after photodynamic therapy, more lugol-voiding lesions representing a squamous cell carcinoma
in situ were found. The patient ultimately underwent surgery for the treatment of recurrent esophageal multifocal neoplasia. After a follow-up period of 3 years, the patient showed a good outcome without symptoms. To manage premalignant lesions such as achalasia with esophageal diverticula, clinicians should be cautious, but have an aggressive approach regarding endoscopic surveillance.-
Citations
Citations to this article as recorded by- Advanced squamous cell carcinoma in an asymptomatic, large, epiphrenic esophageal diverticulum
Tomoaki Yoshida, Satoru Hashimoto, Ken-ichi Mizuno, Hiroshi Ichikawa, Junji Yokoyama, Hajime Umezu, Shuji Terai
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Aina KUNITOMO, Eiji HIGAKI, Tetsuya ABE, Takahiro HOSOI, Seiji ITO, Yasuhiro SHIMIZU
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Diego Palladino, Andrea Mardighian, Marilina D’Amora, Luca Roberto, Francesco Lassandro, Claudia Rossi, Gianluca Gatta, Mariano Scaglione, Guglielmi Giuseppe
Gastroenterology Research and Practice.2016; 2016: 1. CrossRef
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Review
- Peroral Endoscopic Myotomy: Establishing a New Program
- Nikhil A. Kumta, Shivani Mehta, Prashant Kedia, Kristen Weaver, Reem Z. Sharaiha, Norio Fukami, Hitomi Minami, Fernando Casas, Monica Gaidhane, Arnon Lambroza, Michel Kahaleh
- Clin Endosc 2014;47(5):389-397. Published online September 30, 2014
- DOI: https://doi.org/10.5946/ce.2014.47.5.389
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Abstract
PDFPubReaderePub
Achalasia is an esophageal motility disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES) and aperistalsis of the esophageal body. Treatment of achalasia is aimed at decreasing the resting pressure in the LES. Peroral endoscopic myotomy (POEM), derived from natural orifice transluminal endoscopic surgery (NOTES) and advances in endoscopic submucosal dissection (ESD), presents a novel, minimally invasive, and curative endoscopic treatment for achalasia. POEM involves an esophageal mucosal incision followed by creation of a submucosal tunnel crossing the esophagogastric junction and myotomy before closure of the mucosal incision. Although the procedure is technically demanding and requires a certain degree of skill and competency, treatment success is high (90%) with low complication rates. Since the first described POEM in humans in 2010, it has been used increasingly at centers worldwide. This article reviews available published clinical studies demonstrating POEM efficacy and safety in order to present a proposal on how to establish a dedicated POEM program and reach base proficiency for the procedure.
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Original Articles
- Peroral Endoscopic Myotomy for Treatment of Achalasia: Initial Results of a Korean Study
- Byung Hoo Lee, Kwang Yeun Shim, Su Jin Hong, Gene Hyun Bok, Jun-Hyung Cho, Tae Hee Lee, Joo Young Cho
- Clin Endosc 2013;46(2):161-167. Published online March 31, 2013
- DOI: https://doi.org/10.5946/ce.2013.46.2.161
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Abstract
PDFPubReaderePub
Background/Aims Achalasia is a rare esophageal motility disorder. Recently, a novel endoscopic technique, peroral endoscopic myotomy (POEM), was introduced as an alternative treatment for achalasia. We report the results and short term outcomes of POEM for patients with achalasia.
Methods POEM was performed in 13 patients with achalasia. The procedure consisted of creating a submucosal tunnel followed by endoscopic myotomy of circular muscle bundles. The mucosal entry was closed by conventional hemostatic clips. A validated clinical symptom score (Eckardt score) and high resolution manometry were used to evaluate the outcomes.
Results Both the clinical score of achalasia, as well as the resting lower esophageal sphincter (LES) pressure, were significantly reduced after POEM. Mean posttreatment Eckardt score was 0.4±0.7, compared to 6.4±1.9 prior to the treatment (
p =0.001). The mean pretreatment and posttreatment LES pressure was 30.3 and 15.3 mm Hg, respectively (p =0.007). Following POEM, symptomatic relief from dysphagia without reflux symptoms was observed in all patients (13/13). No serious complications related to POEM were encountered.Conclusions Based upon our initial experience, the authors believe that POEM is a feasible, safe, and effective treatment and may possibly substitute established treatments of refractory achalasia.
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- Peroral Endoscopic Myotomy for Treating Achalasia in an Animal Model: A Feasibility Study
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Abstract
PDFPubReaderePub
Background/Aims Laparoscopic Heller myotomy with antireflux procedure is considered to be a standard treatment for achalasia. Recently, peroral endoscopic myotomy (POEM) was developed and performed on patients with achalasia. However, there is no report on POEM use in South Korea. The aim of this study was to evaluate the technical feasibility of POEM in a porcine model.
Methods POEM was performed on two mini pigs. We performed upper endoscopy under general anesthesia. A submucosal tunnel was created and the circular muscle layer was incised using several knives. The mucosal entry was closed using resolution clips. We performed a follow-up endoscopy and sacrificed the pigs 2 weeks after the POEM. The myotomy site was evaluated grossly and histologically.
Results POEM was successfully performed on the two mini pigs. No injuries to any abdominal or mediastinal structures occurred. Two weeks after the POEM, the esophageal mucosa healed without any endoscopic evidence of complications. Necropsy revealed that the circular muscle layer was completely lost and replaced with fibrotic tissue.
Conclusions We found that POEM is a technically feasible method which can be performed on an animal model. However, to ensure safe use on patients with achalasia, further studies on technical methods and long-term follow-up examinations are required.
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Citations
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Review
- Endoscopic Treatment of Primary Esophageal Motility Disorders
- Joon Seong Lee, M.D., Ph.D.
- Korean J Gastrointest Endosc 2011;42(6):341-348. Published online June 21, 2011
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Abstract
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- Treatment of primary esophageal motility disorders, particularly achalasia, has
developed enormously. The proven treatments for these patients include mostly
endoscopic methods. Currently, pneumatic dilatation and laparoscopic myotomy
with partial fundoplication are both useful for treating achalasia. A young man with
high lower esophageal sphincter pressure might be best indicated for a laparoscopic
myotomy with fundoplication, whereas an older patient with a high risk for
surgery or vigorous achalasia may for a candidate for an endoscopic botulinum
toxin injection. Pneumatic balloon dilatation is the choice of treatment for other
case
s of achalasia. The best treatment option for a nonachalasia spastic motor disorder of the esophagus may be endoscopic injection of botulinum toxin. In the future, endoscopic injection of neuronal stem cells could be the best treatment option for achalasia.
- 5,460 View
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- 하부식도 괄약근 이완불능증 환자에 있어서 풍선확장술 결과에 대한 예측인자
- Korean J Gastrointest Endosc 2001;23(5):293-293. Published online November 30, 2000
- 1,873 View
- 4 Download
- 원저 : 식도 위장관 ; 아칼라지아 환자에서 내시경적 하부식도 괄약근내 보툴리늄독소 주사의 효과 ( Original Articles : Esophagus , Stomach & Intestine ; Intrasphincteric Injection of Botulinum Toxin in Patients with Achalasia )
- Korean J Gastrointest Endosc 1998;18(3):297-302. Published online November 30, 1997
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Abstract
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- Background
/Aims: Botulinum toxin(Botox) has long been known as one of the most potent paralytic agents of skeletal muscle, and acts by inhibiting the acetylcholine release from nerve terminals. Recently lacally injected Botox has been found to be effective in the reduction of lower esophageal sphincter(LES) tone in patients with achalasia. The aim of this study was to examine the effects of Botox on patients with achalasia in terms of symptomatic relief and improvement of esophageal function. Methods: Nine patients with achalasia were given endoscopic injections of 100 units of Botox into the LES. One week later, the response to treatment was assessed on the basis of changes in the symptomatic scores, maximal diameters of esophagus clilation on esophagograms, and results of esophageal manometric and scintigraphic studies. Three months later, the symptomatic scores and esophageal manometric results were assessed. Responders to Botox were defined as patients with a decrease in the total symptom score of 50% or more at 1 month of past-treatment without a subsequent treatment. (Korean J Gastrointest Endosc 18: 297-302, 1998) (continue)
- 1,910 View
- 6 Download
- 원저 : 식도 위장관 ; 일차성 식도 이완 불능증에서 내시경적 보툴리늄 독소 주입 치료의 평가 ( Original Articles : Esophagus , Stomach & Intestine ; Clinical Trial of Endoscopic Botulinum Toxin Injection for the Treatment of Primary Achalasia )
- Korean J Gastrointest Endosc 1997;17(6):750-759. Published online November 30, 1996
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Abstract
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- Primary achalasia is a disorder of swallowing in which the lower esophageal sphincter fails to relax. Traditional treatment methods are balloon dilatation and myotomy, but these methods have critical complications and even fatal including esophageal perforation, gastroesophageal reflux, and continuing dysphagia. Botulinum toxin, which has been used for dystonias of skeletal muscles, is presented as a new alternative treatment method for achalasia, aimed to lowering of LES pressure by Pasricha et al. They also reported that endoscopic botulinum toxin injection into LES was effective, safe, and simple method without any significant complication. We report 7 cases of primary achalasia treated with endoscopic botulinum toxin injection, who showed clinical improvement without any complication. We compared results of pre-treatment with those of post-treatment using botulinum toxin in the aspects of clinical, radiological, manometrical recording in these cases. Symptomatic improvement was shown in 4 cases(57.1%), symptom score was decreased from 7.43+- 0.53 to 4.43+- 2.51(p=0.03), The luminal diameter at esophagogastric junction increased from a mean of 3.21+-> 0,99 mm to 5.14+- 0.90 mm (p=0.015), and luminal diameter at esophageal body decreased from a mean of 40.29+- 19.37 mm to 32.71+-15.45 mm (p=0.015). In follow up manometric recording, peristaltic waves at the body were recovered in 2 cases(28.6%), gastroesophageal pressure gradient(AP) was non-significantly decreased from 6.30+-4.0 mmHg to 3.12+-4.47 mmHg (p=0.45). One patient complained of transient chest pain within one hour after the botulinum toxin injection, but she did not need any medication. We concluded that botulinum injection was a simple, safe, and effective therapeutic method for primary achalasia, even though further evaluatian should be performed in the much more cases and the results of long term follow-up, and cost-effectiveness of this method. (Korean J Gastrointest Endosc 17: 750-759, 1997)
- 1,826 View
- 3 Download
- 증례 : 위장관 ; 식도 이완불능증 환자에서 발생한 진행성 식도암 1예 ( Case Reports : Stomach & Intestine ; A Csse of Esophageal Carcinoma in a Patient with Primary Achalasia )
- Korean J Gastrointest Endosc 1997;17(5):656-662. Published online November 30, 1996
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Abstract
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- Achalasia is believed to be a predisposing factor for the development of esophageal cancer. The prevalence rate of esophageal cancer is 1-7% among all patient with achalasia. The presumed mechanism responsible for the development of cancer are food stasis and gastroesophageal reflux. We experienced a case of esophageal carcinoma in a 47-year-old man,who had diagnosed as achalasia ten years ago. Esophagogram, esophagoscopy with biopsy and chest CT scanning can reveal esophageal carcinoma arising in patients with achalasia. (Korean J Gastrointest Endosc 17: 656-660, 1997)
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- 1 Download
- 증례 : 식도 위장관 ; 식도이완 불능증 환자에서 발생한 폐농양 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Lung Abscess in an Achalasia Patient )
- Korean J Gastrointest Endosc 1997;17(4):523-528. Published online November 30, 1996
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Abstract
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- Esophagea1 achalasia is a disease of unkown etiology characterized by abscenee of per- istalsis in the body of the esophagus and failure of the lower esaphageal sphincter to relax in response to swallow. The cause has been suggested by the lack or abscence of ganglion cell in Auerbach's plexus. About 10% of patients with achalasis develop pulmonary complication such as aspiration pnuemonia, pulmonary fibrosis, pulmonary tuberculosis, culosis, bronchiectasis, lung abscess and bronchial asthma. Although aspiration pneumonia is the most common pulmonary complication in patients with achalasia, lung abscess is the extremely rare complication. A 48 years old female, who has experienced dysphagia and regurgitation for several years, is hospitalized because of high fever, cough and sputurn for 2 weeks. Lung abscess in apicoposterior segment of left upper lobe is observed in X-ray and chest CT. The findings of esophagogram, esophagogastroscopy and esophageal manometry are consistent with achalasia. We report a case of lung abscess associated with achalasia. (Korean J Gastrointest Endosc 17: 523-528, 1997)
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- 증례 : 식도근절개술로 치료한 식도이완불능증에서 발생한 Barrett 식도궤양 1예 ( Case Reports : A Case of Barrett's Esophageal Ulcer following Esophagomyotomy for Achalasia )
- Korean J Gastrointest Endosc 1995;15(3):486-493. Published online November 30, 1994
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Abstract
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- We report a patient who developed a Barrett,s esophageal ulcer 10 years after esophagomyotomy for achalasia. A-59-year-old female was admitted to the hospital with dysphagia for 2 months. In 1982, she had undergone a modified Heller esophagomyotomy for achalsia. After esophagogram, esophageal manometry, 24hr esophageal pH monitoring, esophagoscophy achalasia and Barrett,s esophageal ulcer was diagnosed. So, she had been treated with omeprazole and sucralfate and has been followed up in a asymtomatic state currently. In Barrett,s esophagus, there is a metaplasia of the normal stratified squamous mucosa to columnar epithelium, caused by the reflux of acid. It appears in approximately 10% of patients with chronic gastroesophageal reflux and is associated with increased probability of adenocarcinoma of the esophagus. Among the predis- posing factors of gastroesophageal reflux, there is treatment of esophageal achalsia by forceful dilatation or by the esophagomyotomy. The resultant ralaxation of lower esophageal sphinter, combined with deficient propulsive esophageal peristalsis, predisposed to gastroesophageal reflux. Actually an increased incidence of gastroesophageal reflux, esophagitis and stricture are well-known complications after esophagomyotomy. But in spite of higher risk of gastroesophageal reflux after esophagomyotomy the development of Barrett,s mucosa has been rarely reported and only recently recognized. Diagnosis of Barrett,s esophagus in such patients is difficult and the cumulative effects of achalasia and Barrett's esophagus predispose these patient to higher risk of developing esophageal carcinoma. So, high index of awareness and regular endoscopic surveillance are required.
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