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Review
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
AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • The role of cap-assisted endoscopy and its future implications
    Sol Kim, Bo-In Lee
    Clinical Endoscopy.2024; 57(3): 293.     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
  • 4,090 View
  • 352 Download
  • 2 Web of Science
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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
AbstractAbstract 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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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
AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • Development and Validation of Serum Markers as Noninvasive Diagnostic Methods for Achalasia
    Xingyu Jia, Songfeng Chen, Xun Hou, Qianjun Zhuang, Niandi Tan, Mengyu Zhang, Jinhui Wang, Xiangbin Xing, Yinglian Xiao
    Clinical and Translational Gastroenterology.2024; 15(1): e00651.     CrossRef
  • Non-Acid Fluid Exposure and Esophageal Squamous Cell Carcinoma
    Ali Soroush, Arash Etemadi, Julian A. Abrams
    Digestive Diseases and Sciences.2022; 67(7): 2754.     CrossRef
  • Cancer Risk in Patients With Achalasia
    Shreya Chablaney, Rita M. Knotts
    Foregut: The Journal of the American Foregut Society.2022; 2(3): 293.     CrossRef
  • Evaluation of Gastroesophageal Reflux Disease 1 Year after Esophageal Atresia Repair: Paradigms Lost from a Single Snapshot?
    Renato Tambucci, Sara Isoldi, Giulia Angelino, Filippo Torroni, Simona Faraci, Francesca Rea, Erminia Francesca Romeo, Tamara Caldaro, Luciano Guerra, Anna Chiara Iolanda Contini, Monica Malamisura, Giovanni Federici di Abriola, Paola Francalanci, Andrea
    The Journal of Pediatrics.2021; 228: 155.     CrossRef
  • Endoscopic Surveillance in Idiopathic Achalasia
    Olive Ochuba, Sheila W Ruo, Tasnim Alkayyali, Jasmine K Sandhu, Ahsan Waqar, Ashish Jain, Christine Joseph, Kosha Srivastava, Sujan Poudel
    Cureus.2021;[Epub]     CrossRef
  • Histopathological Analysis of Esophageal Mucosa in Patients with Achalasia
    Bong Eun Lee, Gwang Ha Kim, Nari Shin, Do Youn Park, Geun Am Song
    Gut and Liver.2021; 15(5): 713.     CrossRef
  • Eosinophilic esophagitis in esophageal atresia: Tertiary care experience of a “selective” approach for biopsy sampling
    Renato Tambucci, Francesca Rea, Giulia Angelino, Monica Malamisura, Maurizio Mennini, Carla Riccardi, Giovanni Farello, Laura Valfré, Luigi Dall’Oglio, Jonathan E. Markowitz, Alessandro G. Fiocchi, Paola De Angelis
    World Allergy Organization Journal.2020; 13(4): 100116.     CrossRef
  • Achalasia and associated esophageal cancer risk: What lessons can we learn from the molecular analysis of Barrett's–associated adenocarcinoma?
    K. Nesteruk, M.C.W. Spaander, I. Leeuwenburgh, M.P. Peppelenbosch, G.M. Fuhler
    Biochimica et Biophysica Acta (BBA) - Reviews on Cancer.2019; 1872(2): 188291.     CrossRef
  • Retention Esophagitis in Patients with Achalasia Requires Cancer Surveillance
    Eun Jeong Gong, Do Hoon Kim
    Clinical Endoscopy.2018; 51(2): 111.     CrossRef
  • 6,561 View
  • 149 Download
  • 9 Web of Science
  • 9 Crossref
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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
AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • Endoscopic ultrasound-guided drainage of peripancreatic fluid collections: What impacts treatment duration?
    Adam Przybyłkowski, Piotr Nehring
    Hepatobiliary & Pancreatic Diseases International.2023; 22(3): 310.     CrossRef
  • Echo-Endoscopy Combined with Virtual Reality: A Whole Perspective of Laparoscopic Common Bile Duct Exploration in Children
    Francesca Destro, Raffaele Salerno, Valeria Calcaterra, Sandro Ardizzone, Milena Meroni, Margherita Roveri, Ugo Maria Pierucci, Alberta Zaja, Francesco Rizzetto, Alessandro Campari, Maurizio Vertemati, Paolo Milani, Gloria Pelizzo
    Children.2023; 10(4): 760.     CrossRef
  • A National Survey of the Training and Practice Patterns of Practicing Pediatric Advanced Endoscopists in the United States
    Christopher Chu, Paul Tran, Christopher Moreau, Jacob A. Mark, Robert E. Kramer, Travis L. Piester
    Journal of Pediatric Gastroenterology & Nutrition.2023; 77(3): 407.     CrossRef
  • Endoscopic Ultrasound-guided Hepaticogastrostomy in a Seven-year-old Girl
    Shigeto Ishii, Hiroyuki Koga, Hiroaki Saito, Shogo Seo, Mako Ushio, Sho Takahashi, Yusuke Takasaki, Akinori Suzuki, Koichi Ito, Kazushige Ochiai, Ko Tomishima, Toshio Fujisawa, Atsuyuki Yamataka, Shuichiro Shiina, Hiroyuki Isayama
    Internal Medicine.2022; 61(23): 3521.     CrossRef
  • Interventional endoscopy for abdominal transplant patients
    Tom K. Lin, Maisam Abu-El-Haija, Juan P. Gurria, Michelle Saad, David S. Vitale
    Seminars in Pediatric Surgery.2022; 31(3): 151190.     CrossRef
  • Acute recurrent and chronic pancreatitis in children
    Mitsuyoshi Suzuki, Kei Minowa, Hiroyuki Isayama, Toshiaki Shimizu
    Pediatrics International.2021; 63(2): 137.     CrossRef
  • Evolution in the Practice of Pediatric Endoscopy and Sedation
    Conrad B. Cox, Trevor Laborda, J. Matthew Kynes, Girish Hiremath
    Frontiers in Pediatrics.2021;[Epub]     CrossRef
  • EUS in Pediatrics: A Multicenter Experience and Review
    Travis L. Piester, Quin Y. Liu
    Frontiers in Pediatrics.2021;[Epub]     CrossRef
  • The Roles of Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography in the Evaluation and Treatment of Chronic Pancreatitis in Children
    Quin Y. Liu, Roberto Gugig, David M. Troendle, Samuel Bitton, Nishant Patel, David S. Vitale, Maisam Abu‐El‐Haija, Sohail Z. Husain, Veronique D. Morinville
    Journal of Pediatric Gastroenterology and Nutrition.2020; 70(5): 681.     CrossRef
  • Genetic Abnormalities in Pancreatitis: An Update on Diagnosis, Clinical Features, and Treatment
    Mitsuyoshi Suzuki, Kei Minowa, Satoshi Nakano, Hiroyuki Isayama, Toshiaki Shimizu
    Diagnostics.2020; 11(1): 31.     CrossRef
  • Outcome of radiological interventions in pediatric gastrointestinal diseases: A large tertiary center experience
    Zaheer Nabi, Jagadeesh R Singh, Arafat Haris, Upender Shava, Radhika Chavan, Duvvur Nageshwar Reddy
    JGH Open.2019; 3(2): 140.     CrossRef
  • Choledocholithiasis treated with a pediatric duodenoscope in a neonate
    Akihiko Kida, Koichiro Matsuda, Akito Sakai
    Digestive Endoscopy.2019; 31(3): 334.     CrossRef
  • INTRALUMINAL ENDOSCOPY IN CHILDREN - PAST, PRESENT, FUTURE
    Maksim M. Lokhmatov, T. N. Budkina, V. I. Oldakovsky, A. V. Tupylenko, S. I. Ibragimov
    Russian Pediatric Journal.2019; 21(4): 230.     CrossRef
  • Gastrointestinal Polyposis in Pediatric Patients
    Suzanne P. MacFarland, Kristin Zelley, Bryson W. Katona, Benjamin J. Wilkins, Garrett M. Brodeur, Petar Mamula
    Journal of Pediatric Gastroenterology and Nutrition.2019; 69(3): 273.     CrossRef
  • Endoscopic treatment of chronic pancreatitis in pediatric population: Long‐term efficacy and safety
    D Kohoutova, A Tringali, G Papparella, V Perri, I Boškoski, J Hamanaka, G Costamagna
    United European Gastroenterology Journal.2019; 7(2): 270.     CrossRef
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    Claudia Della Corte, Simona Faraci, Fabio Majo, Vincenzina Lucidi, Douglas S. Fishman, Valerio Nobili
    Digestive and Liver Disease.2018; 50(9): 886.     CrossRef
  • 6,867 View
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  • 14 Web of Science
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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
AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • Peroral Endoscopic Myotomy (POEM) in Children: A State of the Art Review
    Ali A. Mencin, Amrita Sethi, Monique T. Barakat, Diana G. Lerner
    Journal of Pediatric Gastroenterology & Nutrition.2022; 75(3): 231.     CrossRef
  • Per-oral endoscopic myotomy (POEM) for a sigmoid type of achalasia: short-term outcomes and changes in the esophageal angle
    Shota Maruyama, Yusuke Taniyama, Tadashi Sakurai, Makoto Hikage, Chiaki Sato, Kai Takaya, Takuro Konno, Takeshi Naitoh, Michiaki Unno, Takashi Kamei
    Surgical Endoscopy.2020; 34(9): 4124.     CrossRef
  • Characteristics of a Subset of Achalasia With Normal Integrated Relaxation Pressure
    Eunju Kim, In Kyung Yoo, Dong Keon Yon, Joo Young Cho, Sung Pyo Hong
    Journal of Neurogastroenterology and Motility.2020; 26(2): 274.     CrossRef
  • Feasibility of using an led-probe in third-space endoscopy: a clinical study
    Oscar Víctor Hernández Mondragón, Raúl Zamarripa Mottú, Omar Solórzano Pineda, Raúl Alberto Gutierrez Aguilar, Luís Fernando García Contreras
    BMC Gastroenterology.2020;[Epub]     CrossRef
  • 2007–2019: a “Third”-Space Odyssey in the Endoscopic Management of Gastrointestinal Tract Diseases
    Anastassios C. Manolakis, Haruhiro Inoue, Akiko Ueno, Yuto Shimamura
    Current Treatment Options in Gastroenterology.2019; 17(2): 202.     CrossRef
  • Treatment of Achalasia with Per-Oral Endoscopic Myotomy: Analysis of 50 Consecutive Patients
    Erica D. Kane, David J. Desilets, Donna Wilson, Marc Leduc, Vikram Budhraja, John R. Romanelli
    Journal of Laparoendoscopic & Advanced Surgical Techniques.2018; 28(5): 514.     CrossRef
  • Two penetrating vessels as a novel indicator of the appropriate distal end of peroral endoscopic myotomy
    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
  • 7,721 View
  • 109 Download
  • 9 Web of Science
  • 7 Crossref
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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
AbstractAbstract 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.

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
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    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
  • 7,123 View
  • 57 Download
  • 6 Web of Science
  • 5 Crossref
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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
AbstractAbstract 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
    Clinical Journal of Gastroenterology.2020; 13(4): 477.     CrossRef
  • Locally Advanced Esophageal Cancer Arising from an Epiphrenic Diverticulum Treated by Curative Esophagectomy Combined with Adjacent Organs Resection
    Aina KUNITOMO, Eiji HIGAKI, Tetsuya ABE, Takahiro HOSOI, Seiji ITO, Yasuhiro SHIMIZU
    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2019; 80(11): 1999.     CrossRef
  • Imaging in the Evaluation of Endoscopic or Surgical Treatment for Achalasia
    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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  • 4 Web of Science
  • 3 Crossref
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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
AbstractAbstract 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.

Citations

Citations to this article as recorded by  
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    Sebastien Rolland, William Paterson, Robert Bechara
    Neurogastroenterology & Motility.2023;[Epub]     CrossRef
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    Pietro Familiari, Federica Borrelli de Andreis, Rosario Landi, Francesca Mangiola, Ivo Boskoski, Andrea Tringali, Vincenzo Perri, Guido Costamagna
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    Afshin Khaiser, Muhammad Baig, David Forcione, Matthew Bechtold, Srinivas R. Puli
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    O.V. Hernández-Mondragón, O.M. Solórzano-Pineda, M.A. González-Martínez, J.M. Blancas-Valencia, C. Caballero-Luengas
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    O.V. Hernández-Mondragón, O.M. Solórzano-Pineda, M.A. González-Martínez, J.M. Blancas-Valencia, C. Caballero-Luengas
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    Seng-Kee Chuah, Chee-Sang Lim, Chih-Ming Liang, Hung-I Lu, Keng-Liang Wu, Chi-Sin Changchien, Wei-Chen Tai
    BioMed Research International.2019; 2019: 1.     CrossRef
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    J Liu, Y Jiao, Y Niu, L Yu, M Ji, S Zhang
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    Nasim Parsa, Mouen A. Khashab
    Current Treatment Options in Gastroenterology.2018; 16(1): 27.     CrossRef
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    Young Kwan Cho, Seong Hwan Kim
    Clinical Endoscopy.2018; 51(1): 13.     CrossRef
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    Oscar M. Crespin, Louis W. C. Liu, Ambica Parmar, Timothy D. Jackson, Jemila Hamid, Eran Shlomovitz, Allan Okrainec
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    Yuki B. Werner, Daniel von Renteln, Tania Noder, Guido Schachschal, Ulrike W. Denzer, Stefan Groth, Jan F. Nast, Jan F. Kersten, Martin Petzoldt, Gerhard Adam, Oliver Mann, Alessandro Repici, Cesare Hassan, Thomas Rösch
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Peroral Endoscopic Myotomy for Treating Achalasia in an Animal Model: A Feasibility Study
Byoung Wook Bang, Young Chul Choi, Hyung Gil Kim, Kye Sook Kwon, Yong Woon Shin, Don Haeng Lee, Joon Mee Kim
Clin Endosc 2013;46(1):54-58.   Published online January 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.1.54
AbstractAbstract 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.

Citations

Citations to this article as recorded by  
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    A. Peñaloza-Ramírez, J. Suárez-Correa, J. Báez-Blanco, C. Sabogal-Gómez, H. Kuan-Casas, C. Sánchez-Pignalosa, P. Aponte-Ordóñez
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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
AbstractAbstract PDF
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.
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