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Haruhiro Inoue - One of the best experts on this subject based on the ideXlab platform.
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Two penetrating vessels as a novel indicator of the appropriate distal end of peroral endoscopic myotomy
Digestive Endoscopy, 2017Co-Authors: Shinwa Tanaka, Haruhiro Inoue, Robert Bechara, Fumiaki Kawara, Takashi Toyonaga, Namiko Hoshi, Hirohumi Abe, Yoshiko Ohara, Tsukasa Ishida, Yoshinori MoritaAbstract:BACKGROUND AND AIM One of the challenges during peroral endoscopic myotomy (POEM) is ensuring the appropriate length of myotomy on the gastric side. To determine the appropriate distal end of the gastric myotomy, we focused on the two penetrating vessels (TPVs) found in the gastric cardia during POEM. In the present study, we evaluated whether the TPVs could serve as an accurate indicator of the appropriate distal end of the gastric myotomy. METHODS All patients who underwent POEM between March and August 2016 were included for this study. When making the submucosal tunnel in the 5 o'clock direction into the stomach, two vessels penetrating through the circular muscle along the edge of oblique muscle in the cardia can be exposed. We designated these two vessels as TPVs. The myotomy was extended until the second TPVs was exposed. The anal end of the submucosal tunnel was confirmed by the double-scope POEM technique, and the length from the gastroesophageal junction to the anal side end of the myotomy was measured by the scale on the endoscope. RESULTS Among 37 patients who underwent myotomy in the 5 o'clock position, TPVs were found in 34 patients (91.2%). Sufficient submucosal tunneling on the gastric side was confirmed by the double-scope POEM technique in these 34 patients. Median length of the gastric myotomy was 3.0 cm (range 2-4 cm). CONCLUSION TPVs appears to be a simple and reliable indicator to determine the appropriate distal end of myotomy.
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double scope per oral endoscopic myotomy poem a prospective randomized controlled trial
Surgical Endoscopy and Other Interventional Techniques, 2016Co-Authors: Kevin L Grimes, Haruhiro Inoue, Manabu Onimaru, Haruo Ikeda, Amarit Tansawet, Robert Bechara, Shinwa TanakaAbstract:Since its introduction in 2010, per oral endoscopic myotomy (POEM) has offered an alternative to laparoscopic Heller myotomy for the treatment of achalasia. A gastric myotomy length of 3 cm has been recommended; however, it can be difficult to ensure that adequate submucosal dissection has been performed during the procedure. Commonly accepted endoscopic markers of the gastric side can be inaccurate, particularly in patients with prior endoscopic treatments, such as balloon dilation or Botox injection of the lower esophageal sphincter. We hypothesized that the use of a second endoscope would result in a more complete gastric myotomy. One hundred consecutive achalasia patients were randomized into single- and double-scope POEM groups. In the treatment group, a second endoscope was used to obtain a retroflexed view of the gastric cardia, while the dissecting scope transilluminated from the end of the submucosal tunnel. Prospectively collected data were analyzed, including myotomy lengths, procedure times, adverse events, and clinical outcomes. POEM was completed with high rates of technical (98–100 %) and clinical success (93–97 %) in both groups, with a low rate of serious adverse events (2 %). The second endoscope resulted in a 17 min increase in procedure time (94 vs. 77 min), myotomy extension in 34 % of cases, and an increase in the average gastric myotomy length from 2.6 to 3.2 cm (p = 0.01). A second endoscope is useful for ensuring a complete gastric myotomy during POEM. With minimal increase in procedure time and no increase in morbidity, it may be particularly useful in cases of sigmoid esophagus or otherwise altered anatomy that makes identification of the gastroesophageal junction difficult.
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efficacy of peroral endoscopic myotomy poem in the treatment of achalasia a systematic review and meta analysis
Surgical Endoscopy and Other Interventional Techniques, 2015Co-Authors: Rupjyoti Talukdar, Haruhiro Inoue, Nageshwar D ReddyAbstract:Background Peroral endoscopic myotomy (POEM) is an evolving therapeutic modality for achalasia. We aim to determine efficacy of POEM for the treatment of achalasia and compare it with laparoscopic Heller’s myotomy (LHM).
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per oral endoscopic myotomy a series of 500 patients
Journal of The American College of Surgeons, 2015Co-Authors: Haruhiro Inoue, Hitomi Minami, Manabu Onimaru, Haruo Ikeda, Hiroki Sato, Chiaki Sato, Kevin L Grimes, Hiroshi Yokomichi, Yasutoshi Kobayashi, Shin-ei KudoAbstract:Background After the first case of per-oral endoscopic myotomy (POEM) at our institution in 2008, the procedure was quickly accepted as an alternative to surgical myotomy and is now established as an excellent treatment option for achalasia. This study aimed to examine the safety and outcomes of POEM at our institution. Study Design Per-oral endoscopic myotomy was performed on 500 consecutive achalasia patients at our institution between September 2008 and November 2013. A review of prospectively collected data was conducted, including procedure time, myotomy location and length, adverse events, and patient data with short- (2 months) and long-term (1 and 3 years) follow-up. Results Per-oral endoscopic myotomy was successfully completed in all patients, with adverse events observed in 3.2%. Two months post-POEM, significant reductions in symptom scores (Eckardt score 6.0 ± 3.0 vs 1.0 ± 2.0, p Conclusions Per-oral endoscopic myotomy was successfully completed in all cases, even when extended indications (extremes of age, previous interventions, or sigmoid esophagus) were used. Adverse events were rare (3.2%), and there were no mortalities. Significant improvements in Eckardt scores and LES pressures were seen at 2 months, 1 year, and 3 years post-POEM. Based on our large series, POEM is a safe and effective treatment for achalasia; there are relatively few contraindications, and the procedure may be used as either first- or second-line therapy.
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greater curvature myotomy is a safe and effective modified technique in per oral endoscopic myotomy with videos
Gastrointestinal Endoscopy, 2015Co-Authors: Manabu Onimaru, Haruhiro Inoue, Haruo Ikeda, Hiroki Sato, Chiaki Sato, Chainarong Phalanusitthepha, Esperanza Grace Santi, Kevin L Grimes, Hiroaki Ito, Shin-ei KudoAbstract:Background Per-oral endoscopic myotomy (POEM) for achalasia with esophagocardiomyotomy in the lesser curvature (LC myotomy) is now established and accepted widely. However, in some cases LC myotomy is precluded by previous procedures, such as Heller myotomy, or by other anatomic considerations that obscure the normal dissection planes. It may also be difficult to identify the esophagogastric junction (EGJ), which can result in an incomplete gastric myotomy and poor rates of symptom relief. On the other hand, the angle of His is always located in the greater curvature of the stomach and serves as a consistent, definite landmark of the gastric side. Objective To evaluate esophagocardiomyotomy in the greater curvature (GC myotomy) as an alternative POEM technique in cases where a prior LC myotomy or supervening anatomic constraints make identification of the EGJ technically challenging. Design Prospective. Setting Single-center study. Patients Twenty-one achalasia patients who received POEM with GC myotomy. Interventions POEM. Main Outcome Measurements Efficacy and safety of GC myotomy measured in terms of reduction in lower esophageal sphincter (LES) pressures, improvement in Eckardt scores, and development of intraoperative or postoperative adverse events. Results Identification of the EGJ was achieved in all cases, resulting in a mean gastric myotomy length of 2.6 ± 1.1 cm. Mean LES pressure and Eckardt symptom scores decreased significantly (21.2 ± 7.3 vs 10.5 ± 2.7 mm Hg, 5 [2-8] vs 1 [0-5], respectively) ( P Limitations Single center. Conclusions GC myotomy is a promising, safe modification of the POEM technique and may be especially useful in cases of redo POEM, POEM post-Heller myotomy, or when the EGJ is difficult to recognize because of supervening anatomic constraints.
Shin-ei Kudo - One of the best experts on this subject based on the ideXlab platform.
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per oral endoscopic myotomy a series of 500 patients
Journal of The American College of Surgeons, 2015Co-Authors: Haruhiro Inoue, Hitomi Minami, Manabu Onimaru, Haruo Ikeda, Hiroki Sato, Chiaki Sato, Kevin L Grimes, Hiroshi Yokomichi, Yasutoshi Kobayashi, Shin-ei KudoAbstract:Background After the first case of per-oral endoscopic myotomy (POEM) at our institution in 2008, the procedure was quickly accepted as an alternative to surgical myotomy and is now established as an excellent treatment option for achalasia. This study aimed to examine the safety and outcomes of POEM at our institution. Study Design Per-oral endoscopic myotomy was performed on 500 consecutive achalasia patients at our institution between September 2008 and November 2013. A review of prospectively collected data was conducted, including procedure time, myotomy location and length, adverse events, and patient data with short- (2 months) and long-term (1 and 3 years) follow-up. Results Per-oral endoscopic myotomy was successfully completed in all patients, with adverse events observed in 3.2%. Two months post-POEM, significant reductions in symptom scores (Eckardt score 6.0 ± 3.0 vs 1.0 ± 2.0, p Conclusions Per-oral endoscopic myotomy was successfully completed in all cases, even when extended indications (extremes of age, previous interventions, or sigmoid esophagus) were used. Adverse events were rare (3.2%), and there were no mortalities. Significant improvements in Eckardt scores and LES pressures were seen at 2 months, 1 year, and 3 years post-POEM. Based on our large series, POEM is a safe and effective treatment for achalasia; there are relatively few contraindications, and the procedure may be used as either first- or second-line therapy.
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greater curvature myotomy is a safe and effective modified technique in per oral endoscopic myotomy with videos
Gastrointestinal Endoscopy, 2015Co-Authors: Manabu Onimaru, Haruhiro Inoue, Haruo Ikeda, Hiroki Sato, Chiaki Sato, Chainarong Phalanusitthepha, Esperanza Grace Santi, Kevin L Grimes, Hiroaki Ito, Shin-ei KudoAbstract:Background Per-oral endoscopic myotomy (POEM) for achalasia with esophagocardiomyotomy in the lesser curvature (LC myotomy) is now established and accepted widely. However, in some cases LC myotomy is precluded by previous procedures, such as Heller myotomy, or by other anatomic considerations that obscure the normal dissection planes. It may also be difficult to identify the esophagogastric junction (EGJ), which can result in an incomplete gastric myotomy and poor rates of symptom relief. On the other hand, the angle of His is always located in the greater curvature of the stomach and serves as a consistent, definite landmark of the gastric side. Objective To evaluate esophagocardiomyotomy in the greater curvature (GC myotomy) as an alternative POEM technique in cases where a prior LC myotomy or supervening anatomic constraints make identification of the EGJ technically challenging. Design Prospective. Setting Single-center study. Patients Twenty-one achalasia patients who received POEM with GC myotomy. Interventions POEM. Main Outcome Measurements Efficacy and safety of GC myotomy measured in terms of reduction in lower esophageal sphincter (LES) pressures, improvement in Eckardt scores, and development of intraoperative or postoperative adverse events. Results Identification of the EGJ was achieved in all cases, resulting in a mean gastric myotomy length of 2.6 ± 1.1 cm. Mean LES pressure and Eckardt symptom scores decreased significantly (21.2 ± 7.3 vs 10.5 ± 2.7 mm Hg, 5 [2-8] vs 1 [0-5], respectively) ( P Limitations Single center. Conclusions GC myotomy is a promising, safe modification of the POEM technique and may be especially useful in cases of redo POEM, POEM post-Heller myotomy, or when the EGJ is difficult to recognize because of supervening anatomic constraints.
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Peroral Endoscopic Myotomy Is a Viable Option for Failed Surgical Esophagocardiomyotomy Instead of Redo Surgical Heller Myotomy: A Single Center Prospective Study
Journal of the American College of Surgeons, 2013Co-Authors: Manabu Onimaru, Haruhiro Inoue, Haruo Ikeda, Hiroki Sato, Akira Yoshida, Esperanza Grace Santi, Hiroaki Ito, Roberta Maselli, Shin-ei KudoAbstract:Background Surgical Heller myotomy has high rates of successful long-term results, but failed cases still remain. Moreover, the treatment strategy in patients with surgical myotomy failure is controversial. Recently, peroral endscopic myotomy (POEM) was reported to be efficient and safe in primary treatment of achalasia. In this study, we aimed to evaluate the efficacy and safety of POEM for surgical myotomy failure as a rescue second-line treatment, and we discuss the treatment options adapted in achalasia recurrence. Study Design A total of 315 consecutive achalasia patients received POEM from September 2008 to December 2012 in our hospital. Eleven (3.5%) patients who had persistent or recurrent achalasia and had received surgical myotomy as a first-line treatment from other hospitals were included in this study. Patient background, barium swallow studies, esophagogastroduodenoscopy (EGD), manometry, and symptom scores were prospectively evaluated. In principle, all patients in whom surgical myotomy failed received pneumatic balloon dilatation (PBD) as the first line "rescue" treatment, and only if PBD failed were patients considered for rescue POEM. Results The PBD alone was effective in 1 patient, and in the remaining 10 patients, rescue POEM was performed successfully without complications. Three months after rescue POEM, significant reduction in lower esophageal sphincter (LES) resting pressures (22.1 ± 6.6 mmHg vs 10.9 ± 4.5 mmHg, p Conclusions Short-term results of POEM for failed surgical myotomy were excellent. Long-term results are awaited.
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Peroral Endoscopic Myotomy for Esophageal Achalasia
Video Journal and Encyclopedia of GI Endoscopy, 2013Co-Authors: Haruhiro Inoue, Hitomi Minami, Manabu Onimaru, Haruo Ikeda, Hiroki Sato, Akira Yoshida, Shin-ei KudoAbstract:Abstract Recent advances in endoscopic technology allow us to perform totally endoscopic myotomy for esophageal achalasia. A submucosal tunnel is first created at the anterior wall of the esophagus down to the gastric cardia. Endoscopic myotomy is carried out in the submucosal tunnel and then completed at the end of the submucosal tunnel. After confirmation of smooth passage of the endoscope through esophago-gastric junction, the mucosal incision is closed using regular hemostatic clips. In 280 consecutive cases of esophageal achalasia peroral endoscopic myotomy was used, except in one case, which received laparoscopic Heller myotomy. Clinical results were excellent, with no significant complication. This article is part of an expert video encyclopedia.
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peroral endoscopic myotomy for esophageal achalasia technique indication and outcomes
Thoracic Surgery Clinics, 2011Co-Authors: Haruhiro Inoue, Hitomi Minami, Manabu Onimaru, Haruo Ikeda, Akira Yoshida, Kris Ma Tianle, Toshihisa Hosoya, Shin-ei KudoAbstract:Peroral endoscopic myotomy (POEM) has been developed as an incisionless, minimally invasive endoscopic treatment intending a permanent cure for esophageal achalasia. The concept of endoscopic myotomy was first reported about 3 decades ago, but the direct incision method through the mucosal layer was not considered to be a safe and reliable approach. A novel method of endoscopic myotomy was developed and established by the authors. In this article, the current techniques, applications, and clinical results of POEM are described.
Yalini Vigneswaran - One of the best experts on this subject based on the ideXlab platform.
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peroral endoscopic myotomy poem feasible as reoperation following heller myotomy
Journal of Gastrointestinal Surgery, 2014Co-Authors: Jin-cheng Zhao, Amy K Yetasook, Woody Denham, Yalini Vigneswaran, John G Linn, Michael B UjikiAbstract:Purpose The purpose of this study was to demonstrate the feasibility of performing peroral endoscopic myotomy (POEM) in the management of recurrent achalasia after failed myotomy.
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peroral endoscopic myotomy poem feasible as reoperation following heller myotomy
Journal of Gastrointestinal Surgery, 2014Co-Authors: Jin-cheng Zhao, Amy K Yetasook, Woody Denham, Yalini Vigneswaran, John G Linn, Michael B UjikiAbstract:The purpose of this study was to demonstrate the feasibility of performing peroral endoscopic myotomy (POEM) in the management of recurrent achalasia after failed myotomy. Eight patients presented to our institution between October 2010 and June 2013 with recurrent/persistent symptoms after prior laparoscopic Heller myotomy. Three patients underwent redo laparoscopic Heller myotomy, and five patients consented to redo myotomy with POEM. Demographics were similar between the groups with exception of age (POEM 69.5 vs. laparoscopic Heller myotomy (LHM) 34.5, p = 0.003). Preoperative Eckardt scores, motility, and prior interventions were not significantly different. Three patients who underwent POEM and two who underwent laparoscopic Heller myotomy had prior fundoplication. There was one perforation identified after laparoscopic Heller myotomy and one patient with persistent subcutaneous emphysema after POEM. Both POEM and laparoscopic Heller myotomy demonstrated significant improvement in symptoms and Eckardt scores at average follow-up of approximately 5 months (p < 0.05). POEM is a feasible option for patients after failed myotomy even in the presence of prior fundoplication. The procedure can be performed safely using a similar technique as for primary myotomy with the exception of creating the myotomy laterally along the right side of the esophagus and lesser curvature avoiding the previous anterior myotomy.
Pinghong Zhou - One of the best experts on this subject based on the ideXlab platform.
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peroral endoscopic myotomy for idiopathic achalasia randomized comparison of water jet assisted versus conventional dissection technique
Surgical Endoscopy and Other Interventional Techniques, 2014Co-Authors: Pinghong Zhou, Meidong Xu, Weifeng Chen, Yun-shi Zhong, Quanlin Li, Jianwei HuAbstract:Background Peroral endoscopic myotomy (POEM) has recently been introduced as a promising alternative to laparoscopic Heller myotomy for idiopathic achalasia. Several proposed technical modifications are yet to be tested in randomized trials.
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Peroral endoscopic myotomy for the treatment of achalasia: a clinical comparative study of endoscopic full-thickness and circular muscle myotomy.
Journal of the American College of Surgeons, 2013Co-Authors: Weifeng Chen, Pinghong Zhou, Li-qing Yao, Ming-yan Cai, Yi-qun Zhang, Wen-zheng Qin, Zhong RenAbstract:Background A circular muscle myotomy preserving the longitudinal outer esophageal muscular layer is often recommended during peroral endoscopic myotomy (POEM) for achalasia. However, because the longitudinal muscle fibers of the esophagus are extremely thin and fragile, and completeness of myotomy is the basis for the excellent results of conventional surgical myotomy, this modification needs to be further debated. Here, we retrospectively analyzed our prospectively maintained POEM database to compare the outcomes of endoscopic full-thickness and circular muscle myotomy. Study Design According to the myotomy depth, 103 patients with full-thickness myotomy were assigned to group A, while 131 patients with circular muscle myotomy were assigned to group B. Symptom relief, procedure-related parameters and adverse events, manometry outcomes, and reflux complications were compared between groups. Results The mean operation times were significantly shorter in group A compared with group B (p = 0.02). There was no increase in any procedure-related adverse event after full-thickness myotomy (all p 0.05). The overall clinical reflux complication rates were also similar (21.2% vs 16.5%, p = 0.38). Conclusions Short-term symptom relief and manometry outcomes of each method were comparable. Full-thickness myotomy significantly reduced the procedure time but did not increase the procedure-related adverse events or clinical reflux complications.
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peroral endoscopic remyotomy for failed heller myotomy a prospective single center study
Endoscopy, 2013Co-Authors: Pinghong Zhou, Meidong Xu, Weifeng Chen, Yongxing Zhang, Jianwei Hu, Quanlin Li, Liang Li, Y S ZhongAbstract:Background and study aims: Recurrence/persistence of symptoms occurs in approximately 20 % of patients after Heller myotomy for achalasia. Controversy exists regarding the therapy for patients in whom Heller myotomy has failed. The aim of the current study was to evaluate the efficacy and feasibility of peroral endoscopic myotomy (POEM), a new endoscopic myotomy technique, for patients with failed Heller myotomy. Patients and methods: A total of 12 patients with recurrence/persistence of symptoms after Heller myotomy, as diagnosed by established methods and an Eckardt score of ≥ 4, were prospectively included. The primary outcome was symptom relief during follow-up, defined as an Eckardt score of ≤ 3. Secondary outcomes were procedure-related adverse events, lower esophageal sphincter (LES) pressure on manometry, reflux symptoms, and medication use before and after POEM. Results: All 12 patients underwent successful POEM after a mean of 11.9 years (range 2 – 38 years) from the time of the primary Heller myotomy. No serious complications related to POEM were encountered. During a mean follow-up period of 10.4 months (range 5 – 14 months), treatment success was achieved in 11/12 patients (91.7 %; mean score pre- vs. post-treatment 9.2 vs. 1.3; P 90 % of cases. Previous Heller myotomy may make subsequent endoscopic remyotomy more challenging, but does not prevent successful POEM.
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peroral endoscopic remyotomy for failed heller myotomy a prospective single center study
Endoscopy, 2013Co-Authors: Pinghong Zhou, Weifeng Chen, Yun-shi Zhong, Y.q. Zhang, Li-qing Yao, Ming-yan Cai, Wen-zheng Qin, Zhao CuiAbstract:Background and study aims: Recurrence/persistence of symptoms occurs in approximately 20 % of patients after Heller myotomy for achalasia. Controversy exists regarding the therapy for patients in whom Heller myotomy has failed. The aim of the current study was to evaluate the efficacy and feasibility of peroral endoscopic myotomy (POEM), a new endoscopic myotomy technique, for patients with failed Heller myotomy. Patients and methods: A total of 12 patients with recurrence/persistence of symptoms after Heller myotomy, as diagnosed by established methods and an Eckardt score of ≥ 4, were prospectively included. The primary outcome was symptom relief during follow-up, defined as an Eckardt score of ≤ 3. Secondary outcomes were procedure-related adverse events, lower esophageal sphincter (LES) pressure on manometry, reflux symptoms, and medication use before and after POEM. Results: All 12 patients underwent successful POEM after a mean of 11.9 years (range 2 – 38 years) from the time of the primary Heller myotomy. No serious complications related to POEM were encountered. During a mean follow-up period of 10.4 months (range 5 – 14 months), treatment success was achieved in 11/12 patients (91.7 %; mean score pre- vs. post-treatment 9.2 vs. 1.3; P Conclusions: POEM seems to be a promising new treatment for failed Heller myotomy resulting in short-term symptom relief in > 90 % of cases. Previous Heller myotomy may make subsequent endoscopic remyotomy more challenging, but does not prevent successful POEM.
Manabu Onimaru - One of the best experts on this subject based on the ideXlab platform.
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double scope per oral endoscopic myotomy poem a prospective randomized controlled trial
Surgical Endoscopy and Other Interventional Techniques, 2016Co-Authors: Kevin L Grimes, Haruhiro Inoue, Manabu Onimaru, Haruo Ikeda, Amarit Tansawet, Robert Bechara, Shinwa TanakaAbstract:Since its introduction in 2010, per oral endoscopic myotomy (POEM) has offered an alternative to laparoscopic Heller myotomy for the treatment of achalasia. A gastric myotomy length of 3 cm has been recommended; however, it can be difficult to ensure that adequate submucosal dissection has been performed during the procedure. Commonly accepted endoscopic markers of the gastric side can be inaccurate, particularly in patients with prior endoscopic treatments, such as balloon dilation or Botox injection of the lower esophageal sphincter. We hypothesized that the use of a second endoscope would result in a more complete gastric myotomy. One hundred consecutive achalasia patients were randomized into single- and double-scope POEM groups. In the treatment group, a second endoscope was used to obtain a retroflexed view of the gastric cardia, while the dissecting scope transilluminated from the end of the submucosal tunnel. Prospectively collected data were analyzed, including myotomy lengths, procedure times, adverse events, and clinical outcomes. POEM was completed with high rates of technical (98–100 %) and clinical success (93–97 %) in both groups, with a low rate of serious adverse events (2 %). The second endoscope resulted in a 17 min increase in procedure time (94 vs. 77 min), myotomy extension in 34 % of cases, and an increase in the average gastric myotomy length from 2.6 to 3.2 cm (p = 0.01). A second endoscope is useful for ensuring a complete gastric myotomy during POEM. With minimal increase in procedure time and no increase in morbidity, it may be particularly useful in cases of sigmoid esophagus or otherwise altered anatomy that makes identification of the gastroesophageal junction difficult.
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per oral endoscopic myotomy a series of 500 patients
Journal of The American College of Surgeons, 2015Co-Authors: Haruhiro Inoue, Hitomi Minami, Manabu Onimaru, Haruo Ikeda, Hiroki Sato, Chiaki Sato, Kevin L Grimes, Hiroshi Yokomichi, Yasutoshi Kobayashi, Shin-ei KudoAbstract:Background After the first case of per-oral endoscopic myotomy (POEM) at our institution in 2008, the procedure was quickly accepted as an alternative to surgical myotomy and is now established as an excellent treatment option for achalasia. This study aimed to examine the safety and outcomes of POEM at our institution. Study Design Per-oral endoscopic myotomy was performed on 500 consecutive achalasia patients at our institution between September 2008 and November 2013. A review of prospectively collected data was conducted, including procedure time, myotomy location and length, adverse events, and patient data with short- (2 months) and long-term (1 and 3 years) follow-up. Results Per-oral endoscopic myotomy was successfully completed in all patients, with adverse events observed in 3.2%. Two months post-POEM, significant reductions in symptom scores (Eckardt score 6.0 ± 3.0 vs 1.0 ± 2.0, p Conclusions Per-oral endoscopic myotomy was successfully completed in all cases, even when extended indications (extremes of age, previous interventions, or sigmoid esophagus) were used. Adverse events were rare (3.2%), and there were no mortalities. Significant improvements in Eckardt scores and LES pressures were seen at 2 months, 1 year, and 3 years post-POEM. Based on our large series, POEM is a safe and effective treatment for achalasia; there are relatively few contraindications, and the procedure may be used as either first- or second-line therapy.
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greater curvature myotomy is a safe and effective modified technique in per oral endoscopic myotomy with videos
Gastrointestinal Endoscopy, 2015Co-Authors: Manabu Onimaru, Haruhiro Inoue, Haruo Ikeda, Hiroki Sato, Chiaki Sato, Chainarong Phalanusitthepha, Esperanza Grace Santi, Kevin L Grimes, Hiroaki Ito, Shin-ei KudoAbstract:Background Per-oral endoscopic myotomy (POEM) for achalasia with esophagocardiomyotomy in the lesser curvature (LC myotomy) is now established and accepted widely. However, in some cases LC myotomy is precluded by previous procedures, such as Heller myotomy, or by other anatomic considerations that obscure the normal dissection planes. It may also be difficult to identify the esophagogastric junction (EGJ), which can result in an incomplete gastric myotomy and poor rates of symptom relief. On the other hand, the angle of His is always located in the greater curvature of the stomach and serves as a consistent, definite landmark of the gastric side. Objective To evaluate esophagocardiomyotomy in the greater curvature (GC myotomy) as an alternative POEM technique in cases where a prior LC myotomy or supervening anatomic constraints make identification of the EGJ technically challenging. Design Prospective. Setting Single-center study. Patients Twenty-one achalasia patients who received POEM with GC myotomy. Interventions POEM. Main Outcome Measurements Efficacy and safety of GC myotomy measured in terms of reduction in lower esophageal sphincter (LES) pressures, improvement in Eckardt scores, and development of intraoperative or postoperative adverse events. Results Identification of the EGJ was achieved in all cases, resulting in a mean gastric myotomy length of 2.6 ± 1.1 cm. Mean LES pressure and Eckardt symptom scores decreased significantly (21.2 ± 7.3 vs 10.5 ± 2.7 mm Hg, 5 [2-8] vs 1 [0-5], respectively) ( P Limitations Single center. Conclusions GC myotomy is a promising, safe modification of the POEM technique and may be especially useful in cases of redo POEM, POEM post-Heller myotomy, or when the EGJ is difficult to recognize because of supervening anatomic constraints.
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Peroral Endoscopic Myotomy Is a Viable Option for Failed Surgical Esophagocardiomyotomy Instead of Redo Surgical Heller Myotomy: A Single Center Prospective Study
Journal of the American College of Surgeons, 2013Co-Authors: Manabu Onimaru, Haruhiro Inoue, Haruo Ikeda, Hiroki Sato, Akira Yoshida, Esperanza Grace Santi, Hiroaki Ito, Roberta Maselli, Shin-ei KudoAbstract:Background Surgical Heller myotomy has high rates of successful long-term results, but failed cases still remain. Moreover, the treatment strategy in patients with surgical myotomy failure is controversial. Recently, peroral endscopic myotomy (POEM) was reported to be efficient and safe in primary treatment of achalasia. In this study, we aimed to evaluate the efficacy and safety of POEM for surgical myotomy failure as a rescue second-line treatment, and we discuss the treatment options adapted in achalasia recurrence. Study Design A total of 315 consecutive achalasia patients received POEM from September 2008 to December 2012 in our hospital. Eleven (3.5%) patients who had persistent or recurrent achalasia and had received surgical myotomy as a first-line treatment from other hospitals were included in this study. Patient background, barium swallow studies, esophagogastroduodenoscopy (EGD), manometry, and symptom scores were prospectively evaluated. In principle, all patients in whom surgical myotomy failed received pneumatic balloon dilatation (PBD) as the first line "rescue" treatment, and only if PBD failed were patients considered for rescue POEM. Results The PBD alone was effective in 1 patient, and in the remaining 10 patients, rescue POEM was performed successfully without complications. Three months after rescue POEM, significant reduction in lower esophageal sphincter (LES) resting pressures (22.1 ± 6.6 mmHg vs 10.9 ± 4.5 mmHg, p Conclusions Short-term results of POEM for failed surgical myotomy were excellent. Long-term results are awaited.
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Peroral Endoscopic Myotomy for Esophageal Achalasia
Video Journal and Encyclopedia of GI Endoscopy, 2013Co-Authors: Haruhiro Inoue, Hitomi Minami, Manabu Onimaru, Haruo Ikeda, Hiroki Sato, Akira Yoshida, Shin-ei KudoAbstract:Abstract Recent advances in endoscopic technology allow us to perform totally endoscopic myotomy for esophageal achalasia. A submucosal tunnel is first created at the anterior wall of the esophagus down to the gastric cardia. Endoscopic myotomy is carried out in the submucosal tunnel and then completed at the end of the submucosal tunnel. After confirmation of smooth passage of the endoscope through esophago-gastric junction, the mucosal incision is closed using regular hemostatic clips. In 280 consecutive cases of esophageal achalasia peroral endoscopic myotomy was used, except in one case, which received laparoscopic Heller myotomy. Clinical results were excellent, with no significant complication. This article is part of an expert video encyclopedia.
