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POEM Contraindications and Pitfalls

  • Rani Modayil
  • Stavros N. StavropoulosEmail author
Chapter
  • 290 Downloads

Abstract

Peroral endoscopic myotomy (POEM), as the first Natural Orifice Transluminal Endoscopic Surgery (NOTES) procedure to gain widespread clinical success, represents a novel type of minimally invasive surgery outside the safe confines of the gastrointestinal lumen, and outside the comfort zone of most endoscopists, particularly gastroenterologists, who are unfamiliar with the hazards of surgery in their day-to-day practice. As such, it carries a much higher risk of severe or life-threatening complications than traditional therapeutic endoscopy. Furthermore, it requires a high level of skill as it attempts to replicate the results of a time-honored laparoscopic operation, the Heller myotomy, with much more basic tools than are available to the laparoscopic surgeon. It follows that in order to maximize efficacy and safety in this technically complex and risky undertaking, the operator needs to be acutely aware of potential pitfalls along with preventive and corrective strategies to address such pitfalls. These strategies consist of “tips and tricks” painstakingly acquired by pioneers and early adopters at high-volume centers, often via an arduous trial-and-error process. Unfortunately, this type of experiential practical information is hard to come by in the peer-reviewed literature which focuses heavily on evidence-based aggregate data to the point of near exclusion of empirical data. We hope that this chapter will help address this knowledge gap particularly for POEM operators early in their learning curve. We review the scant information regarding POEM pitfalls and contraindications gleaned from the literature and augment it with pitfalls, practical tips, and advice from our own extensive experience derived from the largest Western single-operator series at well over 300 POEMs spanning a period of 7 years.

Supplementary material

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Division of Digestive and Liver DiseasesProgram for Advanced GI Endoscopy (PAGE), Winthrop University HospitalMineolaUSA

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