Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bresadola V, Feo CV. Minimally invasive myotomy for the treatment of esophageal achalasia: evolution of the surgical procedure and the therapeutic algorithm. Surg Laparosc Endosc Percutan Tech. 2012 Apr;22(2):83–7. doi:10.1097/SLE.

    Article  PubMed  Google Scholar 

  2. Oelschlager BK. Surgical Options for Treatment of Esophageal Motility Disorders. Gastroenterol Hepatol 2007; 3(9): 687–689.

    Google Scholar 

  3. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S. ''Peroral endoscopic myotomy (POEM) for esophageal achalasia''. Endoscopy. 2010 Apr;42(4):265–71.

    Article  PubMed  CAS  Google Scholar 

  4. Wright AS, Williams CW, Pellegrini CA, Oelschlager BK. Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc. 2007 May;21(5):713–8.

    Article  PubMed  CAS  Google Scholar 

  5. Swanström LL, Rieder E, Dunst CM. ''A stepwise approach and early clinical experience in peroral endoscopic myotomy for the treatment of achalasia and esophageal motility disorders''. J Am Coll Surg. 2011 Dec;213(6):751–6.

    Article  PubMed  Google Scholar 

  6. von Renteln D, Inoue H, Minami H, Werner YB, Pace A, Kersten JF, Much CC, Schachschal G, Mann O, Keller J, Fuchs KH, Rösch T. ''Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study''. Am J Gastroenterol. 2012 Mar;107(3):411–7.

    Article  Google Scholar 

  7. Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstätter M, Lin F, Ciovica R. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009 Jan;249(1):45–57. Doi: 10.1097/SLA.0b013e31818e43ab.

    Article  PubMed  Google Scholar 

  8. Gutschow CA, Töx U, Leers J, Schäfer H, Prenzel KL, Hölscher AH. Botox, dilation, or myotomy? Clinical outcome of interventional and surgical therapies for achalasia. Langenbecks Arch Surg. 2010 Nov;395(8):1093–9.

    Article  PubMed  Google Scholar 

  9. Inoue H, Tianle KM, Ikeda H, Hosoya T, Onimaru M, Yoshida A, Minami H, Kudo SE. Peroral endoscopic myotomy for esophageal achalasia: technique, indication, and outcomes. Thorac Surg Clin. 2011 Nov;21(4):519–25

    Article  PubMed  Google Scholar 

  10. Swanstrom LL, Kurian A, Dunst CM, Sharata A, Bhayani N, Rieder E. Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg. 2012 Oct;256(4):659–67.

    Article  PubMed  Google Scholar 

  11. Rosemurgy AS, Morton CA, Rosas M, Albrink M, Ross SB. A single institution's experience with more than 500 laparoscopic Heller myotomies for achalasia. J Am Coll Surg. 2010 May;210(5):637–45, 645–7

  12. Lynch KL, Pandolfino JE, Howden CW, Kahrilas PJ (2012) Major Complications of Pneumatic Dilation and Heller Myotomy for Achalasia: Single-Center Experience and Systematic Review of the Literature. Am J Gastroenterol, 107(12):1817-25

    Article  PubMed  Google Scholar 

  13. Smith CD, Stival A, Howell DL, Swafford V. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than heller myotomy alone. Ann Surg. 2006 May;243(5):579–84.

    Article  PubMed  Google Scholar 

  14. Portale G, Costantini M, Rizzetto C, Guirroli E, Ceolin M, Salvador R, Ancona E, Zaninotto G. Long-term outcome of laparoscopic Heller-Dor surgery for esophageal achalasia: possible detrimental role of previous endoscopic treatment. J Gastrointest Surg. 2005 Dec;9(9):1332–9.

    Article  PubMed  Google Scholar 

  15. Patti MG, Feo CV, Arcerito M, De Pinto M, Tamburini A, Diener U, Gantert W, Way LW. Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci. 1999 Nov;44(11):2270–6.

    Article  PubMed  CAS  Google Scholar 

  16. Snyder CW, Burton RC, Brown LE, Kakade MS, Finan KR, Hawn MT. Multiple preoperative endoscopic interventions are associated with worse outcomes after laparoscopic Heller myotomy for achalasia. J Gastrointest Surg. 2009 Dec;13(12):2095–103.

    Article  PubMed  Google Scholar 

  17. Schuchert MJ, Luketich JD, Landreneau RJ, Kilic A, Gooding WE, Alvelo-Rivera M, Christie NA, Gilbert S, Pennathur A. Minimally-invasive esophagomyotomy in 200 consecutive patients: factors influencing postoperative outcomes. Ann Thorac Surg. 2008 May;85(5):1729–34.

    Article  PubMed  Google Scholar 

  18. Sweet MP, Nipomnick I, Gasper WJ, Bagatelos K, Ostroff JW, Fisichella PM, Way LW, Patti MG. The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg. 2008 Jan;12(1):159–65.

    Article  PubMed  Google Scholar 

  19. Rakita S, Bloomston M, Villadolid D, Thometz D, Zervos E, Rosemurgy A. Esophagotomy during laparoscopic Heller myotomy cannot be predicted by preoperative therapies and does not influence long-term outcome. J GastrointestSurg. 2005 Feb;9(2):159–64.

    Article  Google Scholar 

  20. Deb S, Deschamps C, Allen MS, Nichols FC 3rd, Cassivi SD, Crownhart BS, Pairolero PC. Laparoscopic esophageal myotomy for achalasia: factors affecting functional results. Ann Thorac Surg. 2005 Oct;80(4):1191–4.

    Article  PubMed  Google Scholar 

  21. Bloomston M, Fraiji E, Boyce HW Jr, Gonzalvo A, Johnson M, Rosemurgy AS. Preoperative intervention does not affect esophageal muscle histology or patient outcomes in patients undergoing laparoscopic Heller myotomy. J Gastrointest Surg. 2003 Feb;7(2):181–8.

    Article  PubMed  Google Scholar 

  22. Cowgill SM, Villadolid DV, Al-Saadi S, Rosemurgy AS. Difficult myotomy is not determined by preoperative therapy and does not impact outcome. JSLS. 2007 Jul-Sep;11(3):336–43

    PubMed  Google Scholar 

  23. Ferulano GP, Dilillo S, D'Ambra M, Lionetti R, Brunaccino R, Fico D, Pelaggi D. Short and long term results of the laparoscopic Heller-Dor myotomy. The influence of age and previous conservative therapies. Surg Endosc. 2007 Nov;21(11):2017–23.

    Article  PubMed  Google Scholar 

  24. Ren Z, Zhong Y, Zhou P, Xu M, Cai M, Li L, Shi Q, Yao L. Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases). Surg Endosc. 2012 Nov;26 (11) :3267–72.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Providence Cancer Center, 4805 NE Glisan Street, #6N60, Portland, OR, 97213, USA

    Ashwin A. Kurian, Neil H. Bhayani & Lee L. Swanström

  2. GI/MIS Division, The Oregon Clinic, Portland, USA

    Ahmed Sharata, Christy M. Dunst, Kevin M. Reavis & Lee L. Swanström

Authors
  1. Ahmed Sharata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashwin A. Kurian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christy M. Dunst
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Neil H. Bhayani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kevin M. Reavis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lee L. Swanström
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lee L. Swanström.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sharata, A., Kurian, A.A., Dunst, C.M. et al. Peroral Endoscopic Myotomy (POEM) Is Safe and Effective in the Setting of Prior Endoscopic Intervention. J Gastrointest Surg 17, 1188–1192 (2013). https://doi.org/10.1007/s11605-013-2193-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-013-2193-6

Keywords

Search

Navigation