Two penetrating vessels as a novel indicator of the appropriate distal end of peroral endoscopic myotomy
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 POE...
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| Veröffentlicht in: | Digestive endoscopy 2018-03, Vol.30 (2), p.206-211 |
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| creator | Tanaka, Shinwa Kawara, Fumiaki Toyonaga, Takashi Inoue, Haruhiro Bechara, Robert Hoshi, Namiko Abe, Hirohumi Ohara, Yoshiko Ishida, Tsukasa Morita, Yoshinori Umegaki, Eiji |
| description | 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. |
| doi_str_mv | 10.1111/den.12957 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1933606988</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1933606988</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4157-d5e93324ca8a4a54438bb29fa6e24e79d7008b63ef0c0e66da05548a8c37248f3</originalsourceid><addsrcrecordid>eNp1kE9PwyAYh4nRuDk9-AUMRz10gxYoPZo5_ySLXua5YfDW1bSlQrel315mpzcJCXnDkyfv74fQNSVTGs7MQDOlccbTEzSmjCURFYKeojHJKI-4SPgIXXj_SUiAGDtHo1hKJiRJx2iz2lvcQgOdU13ZfOAdeA-Vxypc3NgdVLhsTKlVZx22Be42gFXbOtu6UnWATek7VWFozOG3BWfdMFqvbVtqXPe2s3V_ic4KVXm4Or4T9P64WM2fo-Xb08v8fhlpRnkaGQ5ZksRMK6mY4iGMXK_jrFACYgZpZlJC5FokUBBNQAijCOdMKqmTNGaySCbodvCGFb-24Lu8Lr2GqlIN2K3PadALIjIpA3o3oNpZ7x0UechUK9fnlOSHYvNQbP5TbGBvjtrtugbzR_42GYDZAOzLCvr_TfnD4nVQfgPqGoM8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1933606988</pqid></control><display><type>article</type><title>Two penetrating vessels as a novel indicator of the appropriate distal end of peroral endoscopic myotomy</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Tanaka, Shinwa ; Kawara, Fumiaki ; Toyonaga, Takashi ; Inoue, Haruhiro ; Bechara, Robert ; Hoshi, Namiko ; Abe, Hirohumi ; Ohara, Yoshiko ; Ishida, Tsukasa ; Morita, Yoshinori ; Umegaki, Eiji</creator><creatorcontrib>Tanaka, Shinwa ; Kawara, Fumiaki ; Toyonaga, Takashi ; Inoue, Haruhiro ; Bechara, Robert ; Hoshi, Namiko ; Abe, Hirohumi ; Ohara, Yoshiko ; Ishida, Tsukasa ; Morita, Yoshinori ; Umegaki, Eiji</creatorcontrib><description>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.</description><identifier>ISSN: 0915-5635</identifier><identifier>EISSN: 1443-1661</identifier><identifier>DOI: 10.1111/den.12957</identifier><identifier>PMID: 28846807</identifier><language>eng</language><publisher>Australia</publisher><subject>achalasia ; Adult ; Aged ; Cardia - blood supply ; Cardia - surgery ; Cohort Studies ; Esophageal Achalasia - diagnosis ; Esophageal Achalasia - surgery ; Esophageal Sphincter, Lower - surgery ; Esophagoscopy - methods ; Female ; Hospitals, University ; Humans ; indicator ; Japan ; Male ; Manometry - methods ; Middle Aged ; myotomy ; Myotomy - methods ; Natural Orifice Endoscopic Surgery - methods ; peroral endoscopic myotomy (POEM) ; Predictive Value of Tests ; Prospective Studies ; Risk Assessment ; Treatment Outcome ; two penetrating vessels</subject><ispartof>Digestive endoscopy, 2018-03, Vol.30 (2), p.206-211</ispartof><rights>2017 Japan Gastroenterological Endoscopy Society</rights><rights>2017 Japan Gastroenterological Endoscopy Society.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4157-d5e93324ca8a4a54438bb29fa6e24e79d7008b63ef0c0e66da05548a8c37248f3</citedby><cites>FETCH-LOGICAL-c4157-d5e93324ca8a4a54438bb29fa6e24e79d7008b63ef0c0e66da05548a8c37248f3</cites><orcidid>0000-0002-3714-8565</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fden.12957$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fden.12957$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28846807$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tanaka, Shinwa</creatorcontrib><creatorcontrib>Kawara, Fumiaki</creatorcontrib><creatorcontrib>Toyonaga, Takashi</creatorcontrib><creatorcontrib>Inoue, Haruhiro</creatorcontrib><creatorcontrib>Bechara, Robert</creatorcontrib><creatorcontrib>Hoshi, Namiko</creatorcontrib><creatorcontrib>Abe, Hirohumi</creatorcontrib><creatorcontrib>Ohara, Yoshiko</creatorcontrib><creatorcontrib>Ishida, Tsukasa</creatorcontrib><creatorcontrib>Morita, Yoshinori</creatorcontrib><creatorcontrib>Umegaki, Eiji</creatorcontrib><title>Two penetrating vessels as a novel indicator of the appropriate distal end of peroral endoscopic myotomy</title><title>Digestive endoscopy</title><addtitle>Dig Endosc</addtitle><description>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.</description><subject>achalasia</subject><subject>Adult</subject><subject>Aged</subject><subject>Cardia - blood supply</subject><subject>Cardia - surgery</subject><subject>Cohort Studies</subject><subject>Esophageal Achalasia - diagnosis</subject><subject>Esophageal Achalasia - surgery</subject><subject>Esophageal Sphincter, Lower - surgery</subject><subject>Esophagoscopy - methods</subject><subject>Female</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>indicator</subject><subject>Japan</subject><subject>Male</subject><subject>Manometry - methods</subject><subject>Middle Aged</subject><subject>myotomy</subject><subject>Myotomy - methods</subject><subject>Natural Orifice Endoscopic Surgery - methods</subject><subject>peroral endoscopic myotomy (POEM)</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Treatment Outcome</subject><subject>two penetrating vessels</subject><issn>0915-5635</issn><issn>1443-1661</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE9PwyAYh4nRuDk9-AUMRz10gxYoPZo5_ySLXua5YfDW1bSlQrel315mpzcJCXnDkyfv74fQNSVTGs7MQDOlccbTEzSmjCURFYKeojHJKI-4SPgIXXj_SUiAGDtHo1hKJiRJx2iz2lvcQgOdU13ZfOAdeA-Vxypc3NgdVLhsTKlVZx22Be42gFXbOtu6UnWATek7VWFozOG3BWfdMFqvbVtqXPe2s3V_ic4KVXm4Or4T9P64WM2fo-Xb08v8fhlpRnkaGQ5ZksRMK6mY4iGMXK_jrFACYgZpZlJC5FokUBBNQAijCOdMKqmTNGaySCbodvCGFb-24Lu8Lr2GqlIN2K3PadALIjIpA3o3oNpZ7x0UechUK9fnlOSHYvNQbP5TbGBvjtrtugbzR_42GYDZAOzLCvr_TfnD4nVQfgPqGoM8</recordid><startdate>201803</startdate><enddate>201803</enddate><creator>Tanaka, Shinwa</creator><creator>Kawara, Fumiaki</creator><creator>Toyonaga, Takashi</creator><creator>Inoue, Haruhiro</creator><creator>Bechara, Robert</creator><creator>Hoshi, Namiko</creator><creator>Abe, Hirohumi</creator><creator>Ohara, Yoshiko</creator><creator>Ishida, Tsukasa</creator><creator>Morita, Yoshinori</creator><creator>Umegaki, Eiji</creator><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>7X8</scope><orcidid>https://orcid.org/0000-0002-3714-8565</orcidid></search><sort><creationdate>201803</creationdate><title>Two penetrating vessels as a novel indicator of the appropriate distal end of peroral endoscopic myotomy</title><author>Tanaka, Shinwa ; Kawara, Fumiaki ; Toyonaga, Takashi ; Inoue, Haruhiro ; Bechara, Robert ; Hoshi, Namiko ; Abe, Hirohumi ; Ohara, Yoshiko ; Ishida, Tsukasa ; Morita, Yoshinori ; Umegaki, Eiji</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4157-d5e93324ca8a4a54438bb29fa6e24e79d7008b63ef0c0e66da05548a8c37248f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>achalasia</topic><topic>Adult</topic><topic>Aged</topic><topic>Cardia - blood supply</topic><topic>Cardia - surgery</topic><topic>Cohort Studies</topic><topic>Esophageal Achalasia - diagnosis</topic><topic>Esophageal Achalasia - surgery</topic><topic>Esophageal Sphincter, Lower - surgery</topic><topic>Esophagoscopy - methods</topic><topic>Female</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>indicator</topic><topic>Japan</topic><topic>Male</topic><topic>Manometry - methods</topic><topic>Middle Aged</topic><topic>myotomy</topic><topic>Myotomy - methods</topic><topic>Natural Orifice Endoscopic Surgery - methods</topic><topic>peroral endoscopic myotomy (POEM)</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Treatment Outcome</topic><topic>two penetrating vessels</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tanaka, Shinwa</creatorcontrib><creatorcontrib>Kawara, Fumiaki</creatorcontrib><creatorcontrib>Toyonaga, Takashi</creatorcontrib><creatorcontrib>Inoue, Haruhiro</creatorcontrib><creatorcontrib>Bechara, Robert</creatorcontrib><creatorcontrib>Hoshi, Namiko</creatorcontrib><creatorcontrib>Abe, Hirohumi</creatorcontrib><creatorcontrib>Ohara, Yoshiko</creatorcontrib><creatorcontrib>Ishida, Tsukasa</creatorcontrib><creatorcontrib>Morita, Yoshinori</creatorcontrib><creatorcontrib>Umegaki, Eiji</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tanaka, Shinwa</au><au>Kawara, Fumiaki</au><au>Toyonaga, Takashi</au><au>Inoue, Haruhiro</au><au>Bechara, Robert</au><au>Hoshi, Namiko</au><au>Abe, Hirohumi</au><au>Ohara, Yoshiko</au><au>Ishida, Tsukasa</au><au>Morita, Yoshinori</au><au>Umegaki, Eiji</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Two penetrating vessels as a novel indicator of the appropriate distal end of peroral endoscopic myotomy</atitle><jtitle>Digestive endoscopy</jtitle><addtitle>Dig Endosc</addtitle><date>2018-03</date><risdate>2018</risdate><volume>30</volume><issue>2</issue><spage>206</spage><epage>211</epage><pages>206-211</pages><issn>0915-5635</issn><eissn>1443-1661</eissn><abstract>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.</abstract><cop>Australia</cop><pmid>28846807</pmid><doi>10.1111/den.12957</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-3714-8565</orcidid></addata></record> |
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| ispartof | Digestive endoscopy, 2018-03, Vol.30 (2), p.206-211 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | achalasia Adult Aged Cardia - blood supply Cardia - surgery Cohort Studies Esophageal Achalasia - diagnosis Esophageal Achalasia - surgery Esophageal Sphincter, Lower - surgery Esophagoscopy - methods Female Hospitals, University Humans indicator Japan Male Manometry - methods Middle Aged myotomy Myotomy - methods Natural Orifice Endoscopic Surgery - methods peroral endoscopic myotomy (POEM) Predictive Value of Tests Prospective Studies Risk Assessment Treatment Outcome two penetrating vessels |
| title | Two penetrating vessels as a novel indicator of the appropriate distal end of peroral endoscopic myotomy |
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