Clinical Endoscopy

Original Articles

Flexible endoscopic treatment of Zenker’s diverticulum: a retrospective study in a single center from Turkey: Kerem Kenarli, Bülent Ödemiş; Clin Endosc 2025;58(2):261-268. Published online December 12, 2024; DOI: https://doi.org/10.5946/ce.2024.180

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Background
/Aims: We aimed to contribute to the literature by sharing the findings of patients treated by cricopharyngeal myotomy with a flexible endoscopic septal division.
Methods
This retrospective study included patients with Zenker’s diverticulum who underwent cricopharyngeal myotomy with a traditional flexible endoscopic septal division at our center. Clinical success was defined as a significant reduction in dysphagia score, and relapse was defined as an increase in dysphagia score occurring at any time over 1 month after the procedure.
Results
Fifteen patients with symptomatic Zenker’s diverticulum were treated with 16 cricopharyngeal myotomies. A dysphagia score of 100% indicated clinical success, but three (20%) of the patients experienced recurrence during follow-up.
Conclusions
While advances in interventional flexible endoscopy have opened doors for novel treatments, cricopharyngeal myotomy based on traditional flexible endoscopic septal division remains a reliable approach for treating Zenker’s diverticulum.

Citations

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Endoscopic management of hypopharyngeal diverticulum: septotomy versus Zenker’s diverticulum per-oral endoscopic myotomy?
Purnima Bhat, Nicholas G. Burgess
Clinical Endoscopy.2025; 58(2): 253. CrossRef

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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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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

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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

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Review

Anesthesia for Advanced Endoscopic Procedures: Basavana Goudra, Monica Saumoy; Clin Endosc 2022;55(1):1-7. Published online January 3, 2022; DOI: https://doi.org/10.5946/ce.2021.236

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The gastrointestinal endoscopy paradigm is rapidly changing, and technological advancements are largely responsible. In tandem, anesthesia providers are adapting to the changing needs and demands. The challenges are unique. Complications arising from the procedures are both routine, such as aspiration and hypoxia, and procedure specific, such as bleeding, pneumothorax, pneumopericardium, and pneumoperitoneum. It is crucial for the anesthesia provider to have a good understanding of the techniques employed by the endoscopist. A higher index of suspicion is also essential to diagnose and appropriately manage many of the complications. In this review, an effort is made to discuss both procedural aspects and anesthesia challenges. We hope that both endoscopists and anesthesia providers will benefit from this review.

Citations

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Anestezistlerin bidirectional endoskopi işlemlerinde prosedür sırası tercihleri ve belirleyici faktörler
Caner Genç, Sezgin Bilgin, Hasan Çetinkaya, Hatice Selçuk Kuşderci, Sevda Akdeniz, Esra Turunç, Burhan Dost, Özgür Kömürcü
Turkish Journal of Clinics and Laboratory.2025; 16(1): 150. CrossRef
Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Gut and Liver.2024; 18(1): 10. CrossRef
Optimizing perioperative anesthesia strategies for safety and high-quality during painless gastrointestinal endoscopy diagnosis and treatment
Le Xu, Yanhong Li, Hong Zheng, Rurong Wang
Anesthesiology and Perioperative Science.2024;[Epub] CrossRef
Factors affecting patient satisfaction during endoscopic procedures
Ghazala Maryam, Rashk E-Hinna, Saman Sardar, Jahangir Khan, Javaria Isram, Fayyaz Hassan
Scripta Medica.2024; 55(6): 749. CrossRef
Clinical practice guidelines for percutaneous endoscopic gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Clinical Endoscopy.2023; 56(4): 391. CrossRef
Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
The Korean Journal of Gastroenterology.2023; 82(3): 107. 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

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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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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

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; : 502262. 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

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Case Report

Parapneumonic Effusion and Tension Pneumothorax after Diverticular Peroral Endoscopic Myotomy in a Woman with Large Epiphrenic Diverticulum: A Case Report and Literature Review: Sz-Iuan Shiu; Clin Endosc 2021;54(2):275-279. Published online January 15, 2021; DOI: https://doi.org/10.5946/ce.2020.093

Abstract PDF Supplementary Material PubReader ePub: Esophageal diverticula (ED) represents a group of rare conditions that warrant intervention when they are symptomatic or coexisting with pulmonary disorders. Few literature reviews have described this patient entity or discussed the postoperative outcome. Therefore, I present the case of a 59-year-old woman with symptoms of dysphagia who was significantly underweight, which was conducive to the diagnosis of symptomatic ED. Because she was a poor candidate for surgery, she received a diverticular peroral endoscopic myotomy. She subsequently developed parapneumonic effusion and tension pneumothorax after the procedure. She was finally discharged on postoperative day 23. I also performed the first known comprehensive literature review of 34 published cases (including my patient) from PubMed and have addressed the demography, intervention, and prognosis for symptomatic ED after the procedure. Prompt treatment as well as prognostic measurement are crucial to successful outcomes.

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Focused Review Series: Cutting Edges of Advanced Therapeutic Endoscopy

Role of Peroral Endoscopic Myotomy (POEM) in the Management of Esophageal Diverticula: Bogdan P. Miutescu, Sarah Khan, Shruti Mony, Mouen A. Khashab; Clin Endosc 2020;53(6):646-651. Published online November 26, 2020; DOI: https://doi.org/10.5946/ce.2020.262

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Esophageal diverticula are uncommon; however, when present, they can cause symptoms of dysphagia, regurgitation, and chest pain. Based on location and pathophysiological characteristics, they are classified as pulsion- and traction-type diverticula. In the past, the open surgical approach was the only treatment available; however, in the past few decades, transoral incisionless approaches in the form of rigid and flexible endoscopy have gained popularity. Diverticular peroral endoscopic myotomy has emerged as an alternative treatment option. In this paper, we reviewed the role of peroral endoscopic myotomy as a treatment option for different types of esophageal diverticula. Although a safe and effective procedure, this novel submucosal tunneling technique for the treatment of esophageal diverticula requires further validation, and head-to-head comparisons between the different approaches for the treatment of esophageal diverticula are warranted.

Citations

Citations to this article as recorded by

The interventional esophagologist: tunneling a new way forward
Wasseem Skef, Jennifer M Kolb, Salih Samo, Cadman L Legget, Fouad Otaki, Vani J A Konda
Diseases of the Esophagus.2024;[Epub] CrossRef
Efficacy and safety of peroral endoscopic myotomy for esophageal diverticula
Elise M. Wessels, Jeroen M. Schuitenmaker, Barbara A.J. Bastiaansen, Paul Fockens, Gwen M.C. Masclee, Albert J. Bredenoord
Endoscopy International Open.2023; 11(05): E546. CrossRef
Peroral endoscopic myotomy (POEM) for esophageal diverticula
Jayanta SAMANTA, Zaheer NABI, Jahnvi DHAR, Harshal S. MANDAVDHARE
Minerva Gastroenterology.2023;[Epub] CrossRef
Multimodal Endoscopic Management of Esophageal Perforations as a Complication of Peroral Endoscopic Myotomy for a Zenker's Diverticulum
Erlison Mauricio Daza Castro, Carlos Fernando Fuentes, Andrea Carolina Córdoba Guzmán, Diego Aponte, José Nicolás Rocha, Carlos González, Luis Carlos Sabbagh
ACG Case Reports Journal.2023; 10(6): e01059. CrossRef
A rare case of bilateral Killian-Jamieson diverticula treated endoscopically
Catarina Félix, Pedro Barreiro, José Rodrigues, Rui Mendo, Catarina O’Neill, Cristina Chagas
Endoscopy.2022; 54(06): E283. CrossRef
Peroral endoscopic myotomy, septotomy, and restoration of esophageal lumen with over-the-scope clips: closing the circle of esophageal diverticula management
Eduardo Albéniz, Fermín Estremera-Arévalo, Marta Gómez Alonso, Pedro J. Rosón, Francisco J. Gallego Rojo, Juan Vila, Sheyla Montori
Endoscopy.2022; 54(11): E666. CrossRef
Successful D-POEM after failed surgical myotomy and diverticulectomy
Andrew Ross Leopold, Raymond E. Kim
VideoGIE.2022; 7(6): 211. CrossRef
Peroral Endoscopic Myotomy for the Treatment of Esophageal Diverticula
Antonio Facciorusso, Daryl Ramai, Yervant Ichkhanian, Rena Yadlapati, Vito Annese, Sachin Wani, Mouen A. Khashab
Journal of Clinical Gastroenterology.2022; 56(10): 853. CrossRef

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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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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.

Citations

Citations to this article as recorded by

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

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Original Article

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

Abstract PDF Supplementary Material PubReader ePub

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

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

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Case Report

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

Abstract PDF Supplementary Material PubReader ePub: 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.

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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

Abstract PDF PubReader ePub

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

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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
Diseases of the Esophagus.2024;[Epub] CrossRef
Surgical and per-oral endoscopic myotomy (POEM) for the treatment of primary esophageal motility disorders: A systematic analysis of current trends in Germany between 2011 and 2019
Jennis Kandler, Tobias Essing, David Schöler, Georg Flügen, Wolfram T. Knoefel, Christoph Roderburg, Tom Luedde, Sven H. Loosen, Dong Keon Yon
PLOS ONE.2024; 19(1): e0297265. 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
Management of the patient with esophagogastric junction outflow obstruction
Dariush Shahsavari, Zubair Malik, Henry P. Parkman
Current Opinion in Gastroenterology.2021; 37(4): 397. CrossRef
Long-term Outcomes of Per-oral Endoscopic Myotomy in Spastic Esophageal Motility Disorders
Zaheer Nabi, Radhika Chavan, Mohan Ramchandani, Jahangeer Basha, Nitin Jagtap, Arun Karyampudi, Santosh Darisetty, Manu Tandan, Rajesh Goud, Guduru Venkat Rao, Duvvur Nageshwar Reddy
Journal of Clinical Gastroenterology.2021; 55(7): 594. CrossRef
Outcomes of peroral endoscopic myotomy in patients with achalasia and prior bariatric surgery: A multicenter experience
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
Diseases of the Esophagus.2021;[Epub] CrossRef
Spastic Motility Disorders: Diagnosis and Management in the Era of the Chicago Classification
Mario Costantini, Renato Salvador, Andrea Costantini
Foregut: The Journal of the American Foregut Society.2021; 1(3): 254. CrossRef
Non-achalasia esophageal motility disorders: Role of per-oral endoscopic myotomy
Zaheer Nabi, Duvuur Nageshwar Reddy
International Journal of Gastrointestinal Intervention.2020; 9(2): 67. CrossRef
Peroral Endoscopic Myotomy, a Well-Established, Efficacious, and Safe Treatment Option for Achalasia: Is the History of Previous Treatment a Hurdle or Not?
Young Hoon Youn
Clinical Endoscopy.2020; 53(3): 247. CrossRef

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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 PDF Supplementary Material PubReader ePub: 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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Review

Anesthetic Consideration for Peroral Endoscopic Myotomy: Yun-Sic Bang, Chunghyun Park; Clin Endosc 2019;52(6):549-555. Published online July 10, 2019; DOI: https://doi.org/10.5946/ce.2019.033

Abstract PDF PubReader ePub

A recent achalasia guideline suggests that peroral endoscopic myotomy (POEM) is a safe option for achalasia that is as effective as Heller myotomy. It is recommended that POEM should be performed under general anesthesia. The incidence of adverse events such as bleeding, perforation, and carbon dioxide insufflation-related complications was lower in POEM under endotracheal general anesthesia than in POEM under sedation. Subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum, and accompanying hemodynamic instability can be caused by carbon dioxide insufflation. Treatment of possible physiological changes and adverse events during the POEM procedure from the point of view of anesthesiologists may give endoscopists a new perspective on improving patient safety. The territory of therapeutic endoscopy can be expanded through cooperation with other departments, including anesthesia services. Efforts to understand different perspectives will certainly help not only secure patient safety but also expand the area of treatment.

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Focused Review Series: The New Eras of Therapeutic Endoscopy - Endoscopic Submucosal Surgery

Gastric Peroral Endoscopic Myotomy: Hyunsoo Chung, Mouen A Khashab; Clin Endosc 2018;51(1):28-32. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2018.001

Abstract PDF PubReader ePub

Gastroparesis (GP) is a syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach or proximal small bowel. Currently available dietary and medical therapies are limited and have suboptimal efficacy. Pylorus-directed therapies have showed promising results. Gastric peroral endoscopic myotomy (G-POEM) has been reported for the treatment of GP refractory to standard therapy with promising results. This article reviews the current applications and results of G-POEM for the treatment of refractory GP.

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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 PDF PubReader ePub

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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Introduction to Endoscopic Submucosal Surgery: Weon Jin Ko, Joo Young Cho; Clin Endosc 2018;51(1):8-12. Published online January 23, 2018; DOI: https://doi.org/10.5946/ce.2017.154

Abstract PDF PubReader ePub

The concept of using natural orifices to reduce the complications of surgery, Natural Orifices Transluminal Endoscopic Surgery, has also been applied to therapeutic endoscopy. Endoscopic submucosal surgery (ESS) provides more treatment options for various gastrointestinal diseases than traditional therapeutic endoscopy by using the submucosal layer as a working space. ESS has been performed in various fields ranging from transluminal peritoneoscopy to peroral endoscopic myotomy. With further advances in technology, ESS will be increasingly useful for diagnosis and treatment of gastrointestinal diseases.

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Case Report

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 PDF PubReader ePub

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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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

Abstract PDF PubReader ePub

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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POEM in Latin America
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Original Article

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

Abstract PDF PubReader ePub

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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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

Abstract PDF: 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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