As per-oral endoscopic myotomy (POEM) is not followed by any anti-reflux procedure, a common concern is the risk of postoperative gastro-esophageal reflux disease (GERD). Electrical stimulation of the lower esophageal sphincter (LES-EST) could be an option for post-POEM GERD. A 68-year old male obese patient underwent successful POEM but developed GERD not responsive to proton pump inhibitors. Consecutively, the patient had implanted an electrical LES stimulation device, consisting of bipolar LES-electrodes connected to a subcutaneous pulse generator. POEM reduced the Eckardt score (9 vs. 0), the LES resting pressure (52.0 vs. 16.4 mmHg), and the Integrated Relaxation Pressure (62.0 vs. 10.0 mmHg). LES-EST substantially reduced post-POEM GERD symptoms. GERD-HRQL scores indicated the elimination of heartburn (26 vs. 7) and regurgitation (24 vs. 3) at three months. A reduced total number refluxes (82 vs. 14) was observed. The %-time of pH below 4 was only slightly reduced (8.6% to 6.2%).LES-EST appears to be a feasible option to symptomatically treat post-POEM GERD for patients not ideal for conventional anti-reflux surgery.
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[Endoscopic Treatment for Esophageal Achalasia:Per-oral Endoscopic Myotomy( POEM)].
Kyobu Geka
September 2024
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
Per-oral endoscopic myotomy( POEM) is an endoscopic treatment of achalasia. Since the world's first case was performed in Japan in 2008, over 15 years have passed. More than 3,200 cases have been performed at Showa University alone, and over 6,000 cases have been performed throughout Japan.
View Article and Find Full Text PDFSling fiber preservation during POEM reduces incidence of postoperative reflux symptoms.
Dis Esophagus
January 2025
Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Gastroesophageal reflux disease (GERD) after peroral endoscopic myotomy (POEM) has been a limiting factor with POEM. Sling-fiber preservation during POEM was reported to reduce postoperative GERD in Japan. This study investigates the efficacy of this technique in a western population.
View Article and Find Full Text PDFAGA Clinical Practice Update on Advances in Per-Oral Endoscopic Myotomy (POEM) and Remaining Questions-What We Have Learned in the Past Decade: Expert Review.
Gastroenterology
December 2024
Baylor Scott and White Center for Esophageal Diseases, Baylor University Medical Center, Dallas, Texas.
Description: This American Gastroenterological Association (AGA) Institute Clinical Practice Update (CPU) aims to review the available evidence and provide expert advice regarding advances in per-oral endoscopic myotomy (POEM).
Methods: This CPU was commissioned and approved by the AGA Institute CPU Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPU Committee and external peer review through standard procedures of Gastroenterology. This review is framed around best practice advice points agreed upon by the authors, based on the current available evidence and expert opinion in this field.
Recent progress of gastroesophageal reflux after endoscopic myotomy.
World J Gastroenterol
September 2024
Department of Gastroenterology and Hepatology, Guangdong Provincial People's Hospital, Guangzhou 510080, Guangdong Province, China.
Article Synopsis
- - Per-oral endoscopic myotomy (POEM) is a minimally invasive procedure that is increasingly used to treat achalasia and spastic esophageal disorders across specialized medical centers globally.
- - A common complication after undergoing POEM is gastroesophageal reflux (GER), which can impact patients' recovery and quality of life.
- - Recent research offers new insights and strategies to better manage post-POEM GER, providing important implications for endoscopic practices and improving patient outcomes.
Long-term clinical evaluation of a decade with peroral endoscopic myotomy at a single European tertiary center.
Gastrointest Endosc
September 2024
Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Institute of Physiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Medicine, Ostrava University, Ostrava, Czech Republic.
Article Synopsis
- Peroral endoscopic myotomy (POEM) is an effective long-term treatment for achalasia, showing a decline in success rates over time but remaining beneficial for patients, with a success rate dropping from 90.2% at 3 years to 73.5% at 8 years.
- The study analyzed data from 496 patients and identified the year of the procedure as the only predictor of treatment outcomes, with a 10.7% recurrence rate.
- Nearly half of the patients experienced reflux symptoms shortly after the procedure, but these symptoms significantly decreased over time, highlighting the need for proton pump inhibitors (PPIs) early on, with only 39.6% symptomatic at the 2-3 year
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