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 |
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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 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_1364998951</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2988638481</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-f8b0b848b36acf7e6c1fb90bf21dd24b69c2a7d8022d695778ac9af5e1b434c03</originalsourceid><addsrcrecordid>eNp1kMtKAzEUhoMoVqsP4EYCbnQxmpPMZJKllKoFxYIK7kImk9QRm9QkLfTtnVIVN67Ogf8GH0InQC6BkPoqAXBSFQRYQUGygu-gAxA1K0pO-W7_EwkFrarXATpM6Z0QqAmIfTSgjPcSEwdoNrUxRP2Bx74NyYRFZ_DDOuQwX-Pz6eP44QJPEn7SzmLtWzx2zprcrSzuPM5vFj_ZnDs_w8HhaexC_Nsz8dnGlfW5C_4I7Tn9kezx9x2il5vx8-iuuH-8nYyu7wtTMpELJxrSiFI0jGvjassNuEaSxlFoW1o2XBqq61YQSlsuq7oW2kjtKgtNyUpD2BCdbXsXMXwubcrqPSyj7ycVMF5KKWQFvQu2LhNDStE6tYjdXMe1AqI2aNUWrerRqg1axfvM6Xfzspnb9jfxw7I30K0h9ZKf2fhn-t_WL1Vng6A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1364998951</pqid></control><display><type>article</type><title>Peroral Endoscopic Myotomy (POEM) Is Safe and Effective in the Setting of Prior Endoscopic Intervention</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Sharata, Ahmed ; Kurian, Ashwin A. ; Dunst, Christy M. ; Bhayani, Neil H. ; Reavis, Kevin M. ; Swanström, Lee L.</creator><creatorcontrib>Sharata, Ahmed ; Kurian, Ashwin A. ; Dunst, Christy M. ; Bhayani, Neil H. ; Reavis, Kevin M. ; Swanström, Lee L.</creatorcontrib><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.</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 & 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. These interventions do not seem to contribute to increased adverse intraoperative or postoperative clinical outcomes.</description><subject>Abdomen</subject><subject>Body mass index</subject><subject>Botulinum toxin</subject><subject>Botulinum Toxins, Type A</subject><subject>Clinical outcomes</subject><subject>Dilatation</subject><subject>Dysphagia</subject><subject>Endoscopy</subject><subject>Esophageal Motility Disorders - surgery</subject><subject>Esophagoscopy - adverse effects</subject><subject>Esophagoscopy - methods</subject><subject>Esophagus</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>General anesthesia</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Intervention</subject><subject>Laparoscopy</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Motility</subject><subject>Muscle, Smooth - surgery</subject><subject>Natural Orifice Endoscopic Surgery</subject><subject>Original Article</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kMtKAzEUhoMoVqsP4EYCbnQxmpPMZJKllKoFxYIK7kImk9QRm9QkLfTtnVIVN67Ogf8GH0InQC6BkPoqAXBSFQRYQUGygu-gAxA1K0pO-W7_EwkFrarXATpM6Z0QqAmIfTSgjPcSEwdoNrUxRP2Bx74NyYRFZ_DDOuQwX-Pz6eP44QJPEn7SzmLtWzx2zprcrSzuPM5vFj_ZnDs_w8HhaexC_Nsz8dnGlfW5C_4I7Tn9kezx9x2il5vx8-iuuH-8nYyu7wtTMpELJxrSiFI0jGvjassNuEaSxlFoW1o2XBqq61YQSlsuq7oW2kjtKgtNyUpD2BCdbXsXMXwubcrqPSyj7ycVMF5KKWQFvQu2LhNDStE6tYjdXMe1AqI2aNUWrerRqg1axfvM6Xfzspnb9jfxw7I30K0h9ZKf2fhn-t_WL1Vng6A</recordid><startdate>20130701</startdate><enddate>20130701</enddate><creator>Sharata, Ahmed</creator><creator>Kurian, Ashwin A.</creator><creator>Dunst, Christy M.</creator><creator>Bhayani, Neil H.</creator><creator>Reavis, Kevin M.</creator><creator>Swanström, Lee L.</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>20130701</creationdate><title>Peroral Endoscopic Myotomy (POEM) Is Safe and Effective in the Setting of Prior Endoscopic Intervention</title><author>Sharata, Ahmed ; Kurian, Ashwin A. ; Dunst, Christy M. ; Bhayani, Neil H. ; Reavis, Kevin M. ; Swanström, Lee L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-f8b0b848b36acf7e6c1fb90bf21dd24b69c2a7d8022d695778ac9af5e1b434c03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Abdomen</topic><topic>Body mass index</topic><topic>Botulinum toxin</topic><topic>Botulinum Toxins, Type A</topic><topic>Clinical outcomes</topic><topic>Dilatation</topic><topic>Dysphagia</topic><topic>Endoscopy</topic><topic>Esophageal Motility Disorders - surgery</topic><topic>Esophagoscopy - adverse effects</topic><topic>Esophagoscopy - methods</topic><topic>Esophagus</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>General anesthesia</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Intervention</topic><topic>Laparoscopy</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Motility</topic><topic>Muscle, Smooth - surgery</topic><topic>Natural Orifice Endoscopic Surgery</topic><topic>Original Article</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><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><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & 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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