Original articleClinical endoscopyInternational multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video)
Section snippets
Patients and methods
This retrospective study was approved by the Institutional Review Board for Human Research and complied with Health Insurance Portability and Accountability Act regulations at each institution. All patients who underwent POEM for treatment of SED refractory to medical therapy at 11 centers (5 United States, 2 European, and 4 Asian) between January 2011 and November 2013 were included. Diagnosis was based on manometric findings. Relevant clinical (chest pain, Eckardt score), manometric (type of
Results
A total of 73 patients (mean age 58.6 years, 46.5% female) underwent POEM for treatment of SEDs (DES 9 [12.3%], jackhammer esophagus 10 [13.7%], type III achalasia 54 [74%]). Patients presented for POEM after an average of 5.1 years since initial diagnosis. Chest pain was present in 49 patients (67.1%) and 26 (42.6%) reported it as moderate and/or severe. All patients had dysphagia, and 62 (84.9%) reported symptoms of regurgitation (Table 1). Before-POEM manometry revealed a mean 4-second IRP
Discussion
Recent advances in natural orifice transluminal endoscopic surgery17, 18, 19 and the improvement of devices for endoscopic submucosal dissection have culminated in endoluminal approaches to treat achalasia. Submucosal tunneling was initially described by Sumiyama et al,20 whereas POEM was first described by Pasricha et al5 in 2007. Inoue et al6 championed translating this innovative procedure into clinical care. POEM is traditionally performed for achalasia. The role of POEM in the management
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Cited by (0)
DISCLOSURE: M. Khashab is a consultant for Boston Scientific and Olympus America and has received research support from Cook Medical. H. Inoue is a founding member, equity holder, and consultant for Apollo Endosurgery. No other financial relationships relevant to this article were disclosed.
See CME section; p. 1237.
If you would like to chat with an author of this article, you may contact Dr Khashab at [email protected].