Skip to main content
SpringerLink
Log in

Comparative Outcomes: POEM Versus Balloons, Botox, and Surgical Myotomy

  • Chapter
  • First Online:
Per Oral Endoscopic Myotomy (POEM)

Abstract

Symptoms in patients with achalasia are produced by outflow obstruction at the level of the lower esophageal sphincter (LES). As a consequence of neural destruction, the LES does not undergo normal swallow-induced relaxation. In addition, the esophageal body loses normal peristaltic function and esophageal emptying is on the basis of gravity. All therapies for achalasia are palliative in that normal LES or esophageal body function cannot be restored. The efficacy of any therapy for achalasia is directly related to its ability to reduce the outflow obstruction at the LES. The three main treatment options are pneumatic dilatation, laparoscopic myotomy with partial fundoplication, and per-oral endoscopic myotomy (POEM). Details of the procedures and outcomes will be discussed.

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

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–74.

    Article  CAS  PubMed  Google Scholar 

  2. Rohof WO, Salvador R, Annese V, et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology. 2013;144:718–25. Quiz e713–4.

    Article  PubMed  Google Scholar 

  3. Salvador R, Costantini M, Zaninotto G, et al. The preoperative manometric pattern predicts the outcome of surgical treatment for esophageal achalasia. J Gastrointest Surg. 2010;14:1635–45.

    Article  PubMed  Google Scholar 

  4. Gutschow CA, Tox U, Leers J, et al. Botox, dilation, or myotomy? Clinical outcome of interventional and surgical therapies for achalasia. Langenbecks Arch Surg. 2010;395:1093–9.

    Article  PubMed  Google Scholar 

  5. Boeckxstaens GE, Annese V, des Varannes SB, et al. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 2011;364:1807–16.

    Article  CAS  PubMed  Google Scholar 

  6. Katsinelos P, Kountouras J, Paroutoglou G, et al. Long-term results of pneumatic dilation for achalasia: a 15 years’ experience. World J Gastroenterol. 2005;11:5701–5.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Pellegrini C, Wetter LA, Patti M, et al. Thoracoscopic esophagomyotomy. Initial experience with a new approach for the treatment of achalasia. Ann Surg. 1992;216:291–6. Discussion 296–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Patti MG, Pellegrini CA, Horgan S, et al. Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg. 1999;230:587–93. Discussion 593–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Richards WO, Torquati A, Holzman MD, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004;240:405–12. Discussion 412–5.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg. 2003;138:490–5. Discussion 495–7.

    Article  PubMed  Google Scholar 

  11. Khajanchee YS, Kanneganti S, Leatherwood AE, et al. Laparoscopic Heller myotomy with Toupet fundoplication: outcomes predictors in 121 consecutive patients. Arch Surg. 2005;140:827–33. Discussion 833–4.

    Article  PubMed  Google Scholar 

  12. Kilic A, Schuchert MJ, Pennathur A, et al. Long-term outcomes of laparoscopic Heller myotomy for achalasia. Surgery. 2009;146:826–31. Discussion 831–3.

    Article  PubMed  Google Scholar 

  13. Csendes A, Braghetto I, Burdiles P, et al. Very late results of esophagomyotomy for patients with achalasia: clinical, endoscopic, histologic, manometric, and acid reflux studies in 67 patients for a mean follow-up of 190 months. [see comment]. Ann Surg. 2006;243:196–203.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Zaninotto G, Costantini M, Rizzetto C, et al. Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg. 2008;248:986–93.

    Article  PubMed  Google Scholar 

  15. Lopushinsky SR, Urbach DR. Pneumatic dilatation and surgical myotomy for achalasia. JAMA. 2006;296:2227–33.

    Article  CAS  PubMed  Google Scholar 

  16. Niebisch S, Fleming FJ, Galey KM, et al. Perioperative risk of laparoscopic fundoplication: safer than previously reported-analysis of the American College of Surgeons National Surgical Quality Improvement Program 2005 to 2009. J Am Coll Surg. 2012;215:61–8. Discussion 68–9.

    Article  PubMed  Google Scholar 

  17. Lynch KL, Pandolfino JE, Howden CW, Kahrilas PJ. Major complications of pneumatic dilation and Heller myotomy for achalasia: single-center experience and systematic review of the literature. Am J Gastroenterol. 2012;107:1817–25.

    Article  PubMed  Google Scholar 

  18. Patti MG, Feo CV, Arcerito M, et al. Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci. 1999;44:2270–6.

    Article  CAS  PubMed  Google Scholar 

  19. Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71.

    Article  CAS  PubMed  Google Scholar 

  20. Teitelbaum EN, Soper NJ, Arafat FO, et al. Analysis of a learning curve and predictors of intraoperative difficulty for peroral esophageal myotomy (POEM). J Gastrointest Surg. 2014;18:92–8. Discussion 98–9.

    Article  PubMed  Google Scholar 

  21. Kurian AA, Dunst CM, Sharata A, et al. Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc. 2013;77:719–25.

    Article  PubMed  Google Scholar 

  22. Li QL, Zhou PH. Perspective on peroral endoscopic myotomy for achalasia: Zhongshan experience. Gut Liver. 2015;9:152–8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Li QL, Zhou PH, Yao LQ, et al. Early diagnosis and management of delayed bleeding in the submucosal tunnel after peroral endoscopic myotomy for achalasia (with video). Gastrointest Endosc. 2013;78:370–4.

    Article  PubMed  Google Scholar 

  24. Inoue H, Sato H, Ikeda H, et al. Per-oral endoscopic myotomy: a series of 500 patients. J Am Coll Surg. 2015;221:256–64.

    Article  PubMed  Google Scholar 

  25. Swanstrom LL, Kurian A, Dunst CM, et al. Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg. 2012;256:659–67.

    Article  PubMed  Google Scholar 

  26. Von Renteln D, Fuchs KH, Fockens P, et al. Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology. 2013;145:309–311.e301–303.

    Article  Google Scholar 

  27. Greene CL, Chang EJ, Oh DS, et al. High resolution manometry sub-classification of achalasia: does it really matter?: does achalasia sub-classification matter? Surg Endosc. 2015;29(6):1363–7.

    Article  PubMed  Google Scholar 

  28. Hungness ES, Teitelbaum EN, Santos BF, et al. Comparison of perioperative outcomes between peroral esophageal myotomy (POEM) and laparoscopic Heller myotomy. J Gastrointest Surg. 2013;17:228–35.

    Article  PubMed  Google Scholar 

  29. Bhayani N, Kurian A, Dunst CM, et al. A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann Surg. 2014;259:1098–103.

    Article  PubMed  Google Scholar 

  30. Zhang Y, Wang H, Chen X, et al. Per-oral endoscopic myotomy versus laparoscopic Heller myotomy for achalasia: a meta-analysis of nonrandomized comparative studies. Medicine. 2016;95:e2736.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Foregut and Thoracic Surgery, Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, 4805 NE Glisan Street, Ste 6N60, Portland, OR, 97213, USA

    Steven R. DeMeester M.D., F.A.C.S.

Authors
  1. Steven R. DeMeester M.D., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven R. DeMeester M.D., F.A.C.S. .

Editor information

Editors and Affiliations

  1. Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA

    Kevin M. Reavis

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

DeMeester, S.R. (2017). Comparative Outcomes: POEM Versus Balloons, Botox, and Surgical Myotomy. In: Reavis, K. (eds) Per Oral Endoscopic Myotomy (POEM). Springer, Cham. https://doi.org/10.1007/978-3-319-50051-5_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-50051-5_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-50049-2

  • Online ISBN: 978-3-319-50051-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation