Peroral Endoscopic Myotomy (POEM) Is Safe and Effective in the Setting of Prior Endoscopic Intervention

Objective We aimed to determine the safety and feasibility of peroral endoscopic myotomy (POEM) in the setting of prior endoscopic interventions. Patients This study involves 40 consecutive patients undergoing POEM. Intervention POEM was performed for esophageal motility disorders, including achalas...

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Veröffentlicht in:Journal of gastrointestinal surgery 2013-07, Vol.17 (7), p.1188-1192
Hauptverfasser: Sharata, Ahmed, Kurian, Ashwin A., Dunst, Christy M., Bhayani, Neil H., Reavis, Kevin M., Swanström, Lee L.
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container_end_page 1192
container_issue 7
container_start_page 1188
container_title Journal of gastrointestinal surgery
container_volume 17
creator Sharata, Ahmed
Kurian, Ashwin A.
Dunst, Christy M.
Bhayani, Neil H.
Reavis, Kevin M.
Swanström, Lee L.
description Objective We aimed to determine the safety and feasibility of peroral endoscopic myotomy (POEM) in the setting of prior endoscopic interventions. Patients This study involves 40 consecutive patients undergoing POEM. Intervention POEM was performed for esophageal motility disorders, including achalasia, nutcracker with nonrelaxing lower esophageal sphincter (LES), hypertensive lower esophageal sphincter, and diffuse esophageal spasm. Main Outcome Measures Outcome measures include length of procedure (LOP), intraoperative complications, and dysphagia relief. Results Forty patients, with a mean age of 54 ± 19 years, underwent POEM. The pre-POEM intervention group consisted of 12 patients (nine achalasia, two nutcracker with nonrelaxing LES, and one diffuse esophageal spasm) who also had previous endoscopic treatment, while the pre-POEM non-intervention group consisted of 28 patients (22 achalasia, 3 hypertensive LES, 2 nutcracker with nonrelaxing LES, and 1 diffuse esophageal spasm). Ten patients had botox injections and two patients had large caliber balloon dilations prior to POEM. The median preoperative Eckardt score was 5 in the pre-POEM intervention group vs 6 in the pre-POEM non-intervention group ( p value = 0.4). There was no statistical difference in the mean LOP (134 ± 43 vs 131 ± 41, p  = 0.8) or the incidence of intraoperative complications (17 vs 3 %, p  = 0.2) between the two groups. There was also no difference in the 6-month postoperative median Eckardt scores between the two groups (1 vs 1, p  = 0.4). Conclusion POEM is safe and effective even following preoperative endoscopic large caliber balloon dilations or botox injection. These interventions do not seem to contribute to increased adverse intraoperative or postoperative clinical outcomes.
doi_str_mv 10.1007/s11605-013-2193-6
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Patients This study involves 40 consecutive patients undergoing POEM. Intervention POEM was performed for esophageal motility disorders, including achalasia, nutcracker with nonrelaxing lower esophageal sphincter (LES), hypertensive lower esophageal sphincter, and diffuse esophageal spasm. Main Outcome Measures Outcome measures include length of procedure (LOP), intraoperative complications, and dysphagia relief. Results Forty patients, with a mean age of 54 ± 19 years, underwent POEM. The pre-POEM intervention group consisted of 12 patients (nine achalasia, two nutcracker with nonrelaxing LES, and one diffuse esophageal spasm) who also had previous endoscopic treatment, while the pre-POEM non-intervention group consisted of 28 patients (22 achalasia, 3 hypertensive LES, 2 nutcracker with nonrelaxing LES, and 1 diffuse esophageal spasm). Ten patients had botox injections and two patients had large caliber balloon dilations prior to POEM. The median preoperative Eckardt score was 5 in the pre-POEM intervention group vs 6 in the pre-POEM non-intervention group ( p value = 0.4). There was no statistical difference in the mean LOP (134 ± 43 vs 131 ± 41, p  = 0.8) or the incidence of intraoperative complications (17 vs 3 %, p  = 0.2) between the two groups. There was also no difference in the 6-month postoperative median Eckardt scores between the two groups (1 vs 1, p  = 0.4). Conclusion POEM is safe and effective even following preoperative endoscopic large caliber balloon dilations or botox injection. These interventions do not seem to contribute to increased adverse intraoperative or postoperative clinical outcomes.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-013-2193-6</identifier><identifier>PMID: 23609138</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdomen ; Body mass index ; Botulinum toxin ; Botulinum Toxins, Type A ; Clinical outcomes ; Dilatation ; Dysphagia ; Endoscopy ; Esophageal Motility Disorders - surgery ; Esophagoscopy - adverse effects ; Esophagoscopy - methods ; Esophagus ; Feasibility Studies ; Female ; Gastroenterology ; General anesthesia ; Humans ; Hypertension ; Intervention ; Laparoscopy ; Male ; Medicine ; Medicine &amp; Public Health ; Middle Aged ; Motility ; Muscle, Smooth - surgery ; Natural Orifice Endoscopic Surgery ; Original Article ; Patients ; Retrospective Studies ; Surgery</subject><ispartof>Journal of gastrointestinal surgery, 2013-07, Vol.17 (7), p.1188-1192</ispartof><rights>The Society for Surgery of the Alimentary Tract 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-f8b0b848b36acf7e6c1fb90bf21dd24b69c2a7d8022d695778ac9af5e1b434c03</citedby><cites>FETCH-LOGICAL-c438t-f8b0b848b36acf7e6c1fb90bf21dd24b69c2a7d8022d695778ac9af5e1b434c03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-013-2193-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-013-2193-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23609138$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sharata, Ahmed</creatorcontrib><creatorcontrib>Kurian, Ashwin A.</creatorcontrib><creatorcontrib>Dunst, Christy M.</creatorcontrib><creatorcontrib>Bhayani, Neil H.</creatorcontrib><creatorcontrib>Reavis, Kevin M.</creatorcontrib><creatorcontrib>Swanström, Lee L.</creatorcontrib><title>Peroral Endoscopic Myotomy (POEM) Is Safe and Effective in the Setting of Prior Endoscopic Intervention</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>Objective We aimed to determine the safety and feasibility of peroral endoscopic myotomy (POEM) in the setting of prior endoscopic interventions. Patients This study involves 40 consecutive patients undergoing POEM. Intervention POEM was performed for esophageal motility disorders, including achalasia, nutcracker with nonrelaxing lower esophageal sphincter (LES), hypertensive lower esophageal sphincter, and diffuse esophageal spasm. Main Outcome Measures Outcome measures include length of procedure (LOP), intraoperative complications, and dysphagia relief. Results Forty patients, with a mean age of 54 ± 19 years, underwent POEM. The pre-POEM intervention group consisted of 12 patients (nine achalasia, two nutcracker with nonrelaxing LES, and one diffuse esophageal spasm) who also had previous endoscopic treatment, while the pre-POEM non-intervention group consisted of 28 patients (22 achalasia, 3 hypertensive LES, 2 nutcracker with nonrelaxing LES, and 1 diffuse esophageal spasm). Ten patients had botox injections and two patients had large caliber balloon dilations prior to POEM. The median preoperative Eckardt score was 5 in the pre-POEM intervention group vs 6 in the pre-POEM non-intervention group ( p value = 0.4). There was no statistical difference in the mean LOP (134 ± 43 vs 131 ± 41, p  = 0.8) or the incidence of intraoperative complications (17 vs 3 %, p  = 0.2) between the two groups. There was also no difference in the 6-month postoperative median Eckardt scores between the two groups (1 vs 1, p  = 0.4). Conclusion POEM is safe and effective even following preoperative endoscopic large caliber balloon dilations or botox injection. 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Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sharata, Ahmed</au><au>Kurian, Ashwin A.</au><au>Dunst, Christy M.</au><au>Bhayani, Neil H.</au><au>Reavis, Kevin M.</au><au>Swanström, Lee L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Peroral Endoscopic Myotomy (POEM) Is Safe and Effective in the Setting of Prior Endoscopic Intervention</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2013-07-01</date><risdate>2013</risdate><volume>17</volume><issue>7</issue><spage>1188</spage><epage>1192</epage><pages>1188-1192</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>Objective We aimed to determine the safety and feasibility of peroral endoscopic myotomy (POEM) in the setting of prior endoscopic interventions. Patients This study involves 40 consecutive patients undergoing POEM. Intervention POEM was performed for esophageal motility disorders, including achalasia, nutcracker with nonrelaxing lower esophageal sphincter (LES), hypertensive lower esophageal sphincter, and diffuse esophageal spasm. Main Outcome Measures Outcome measures include length of procedure (LOP), intraoperative complications, and dysphagia relief. Results Forty patients, with a mean age of 54 ± 19 years, underwent POEM. The pre-POEM intervention group consisted of 12 patients (nine achalasia, two nutcracker with nonrelaxing LES, and one diffuse esophageal spasm) who also had previous endoscopic treatment, while the pre-POEM non-intervention group consisted of 28 patients (22 achalasia, 3 hypertensive LES, 2 nutcracker with nonrelaxing LES, and 1 diffuse esophageal spasm). Ten patients had botox injections and two patients had large caliber balloon dilations prior to POEM. The median preoperative Eckardt score was 5 in the pre-POEM intervention group vs 6 in the pre-POEM non-intervention group ( p value = 0.4). There was no statistical difference in the mean LOP (134 ± 43 vs 131 ± 41, p  = 0.8) or the incidence of intraoperative complications (17 vs 3 %, p  = 0.2) between the two groups. There was also no difference in the 6-month postoperative median Eckardt scores between the two groups (1 vs 1, p  = 0.4). Conclusion POEM is safe and effective even following preoperative endoscopic large caliber balloon dilations or botox injection. These interventions do not seem to contribute to increased adverse intraoperative or postoperative clinical outcomes.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>23609138</pmid><doi>10.1007/s11605-013-2193-6</doi><tpages>5</tpages></addata></record>
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subjects Abdomen
Body mass index
Botulinum toxin
Botulinum Toxins, Type A
Clinical outcomes
Dilatation
Dysphagia
Endoscopy
Esophageal Motility Disorders - surgery
Esophagoscopy - adverse effects
Esophagoscopy - methods
Esophagus
Feasibility Studies
Female
Gastroenterology
General anesthesia
Humans
Hypertension
Intervention
Laparoscopy
Male
Medicine
Medicine & Public Health
Middle Aged
Motility
Muscle, Smooth - surgery
Natural Orifice Endoscopic Surgery
Original Article
Patients
Retrospective Studies
Surgery
title Peroral Endoscopic Myotomy (POEM) Is Safe and Effective in the Setting of Prior Endoscopic Intervention
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