Peroral endoscopic myotomy for a pediatric case of suspected congenital esophageal stenosis.
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ABSTRACT:
SUBMITTER: Abe H
PROVIDER: S-EPMC10751455 | biostudies-literature | 2023 Dec
REPOSITORIES: biostudies-literature
Publications
Peroral endoscopic myotomy for a pediatric case of suspected congenital esophageal stenosis.
Abe Hirofumi H Motomura Douglas D Tanaka Shinwa S Sakaguchi Hiroya H Tanabe Hiroshi H Hori Hitomi H Toyonaga Takashi T Kodama Yuzo Y
VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 20230819 12
Video 1Peroral endoscopic myotomy for a pediatric case of suspected congenital esophageal stenosis. ...[more]
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Project description:BackgroundCongenital esophageal stenosis (CES) in adults is a rare disorder that can present as achalasia, particularly in the distal esophagus. We describe the salient features of CES in adults and identify the feasibility and short-term outcomes of peroral endoscopic myotomy (POEM) for CES.MethodsIn this retrospective, single-center case series, we included 6 patients with a "misdiagnosis" of achalasia established elsewhere, ultimately diagnosed with CES and referred to our institution for POEM. Symptom improvement (clinical success rate), defined as an Eckardt Symptom Score (ESS) of <3 at 2-month follow up was assessed.ResultsSix patients (median age: 40 [range: 18-58] years; 4 males) were included. A long-standing history of dysphagia, ring-shaped stenosis on endoscopic examination, "lopsided hourglass" sign on barium esophagogram, and high-resolution manometry findings indicated by a compartmentalized intrabolus pressure pattern with distinction between the stenotic area and the lower esophageal sphincter were the salient features identified. POEM could not be completed in the first 2 cases due to technical challenges. All subsequent 4 patients who underwent successful POEM, exhibited improved ESS of ≤3 (clinical success rate 100%) at 2 months post-POEM.ConclusionsAlong with identification of salient features on several diagnostic modalities, a differential diagnosis of CES in adults must be considered in patients presenting with long-standing history of dysphagia arising from childhood and persisting into adulthood. Although favorable short-term outcomes of POEM were achieved, further evaluation is still warranted, and an inexperienced operator should not attempt POEM on CES patients due to its technical difficulties.
| S-EPMC8276369 | biostudies-literature
Project description:This paper presented a case of esophageal achalasia treated by peroral endoscopic myotomy with HybridKnife and discuss the feasibility and the possible advantages of using it.
| S-EPMC3415097 | biostudies-literature
Project description:Background and study aims Epiphrenic diverticula are rare and mainly occur in patients with underlying esophageal motility disorders. The current standard treatment is surgical diverticulectomy often combined by myotomy and is associated with significant adverse event (AE) rates. The aim of this study was to examine the efficacy and safety of peroral endoscopic myotomy in reducing esophageal symptoms in patients with esophageal diverticula. Patients and methods We performed a retrospective cohort study including patients with an esophageal diverticulum who underwent POEM between October 2014 and December 2022. After informed consent, data were extracted from medical records and patients completed a survey by telephone. The primary outcome was treatment success, defined as Eckardt score below 4 with a minimal reduction of 2 points. Results Seventeen patients (mean age 71 years, 41.2 % female) were included. Achalasia was confirmed in 13 patients (13 /17, 76.5 %), Jackhammer esophagus in two patients (2 /17, 11.8 %), diffuse esophageal spasm in one patient (1 /17, 5.9 %) and in one patient no esophageal motility disorder was found (1 /17, 5.9 %). Treatment success was 68.8 % and only one patient (6.3 %) underwent retreatment (pneumatic dilatation). Median Eckardt scores decreased from 7 to 1 after POEM (p < 0.001). Mean size of the diverticula decreased from 3.6 cm to 2.9 cm after POEM (p < 0.001). Clinical admission was one night for all patients. AEs occurred in two patients (11.8 %) which were classified as grade II and IIIa (AGREE classification). Conclusions POEM is effective and safe to treat patients with esophageal diverticula and an underlying esophageal motility disorder.
| S-EPMC10219786 | biostudies-literature
Project description:Video 1Modified gastric-peroral endoscopic myotomy with sleeve release in a case of severe gastric sleeve stenosis.
| S-EPMC10794108 | biostudies-literature
Project description:Background/aimsSeveral studies have reported partial recovery of peristalsis in patients with achalasia after myotomy. The aim of our study is to analyze esophageal motility patterns after peroral endoscopic myotomy (POEM) and to assess the potential predictors and clinical impact of peristaltic recovery.MethodsWe performed a retrospective analysis of prospectively collected data of consecutive patients with achalasia undergoing POEM at a tertiary center. High-resolution manometry (HRM) studies prior to and after POEM were reviewed and the Chicago classification was applied.ResultsA total of 237 patients were analyzed. The initial HRM diagnoses were achalasia type I, 42 (17.7%); type II, 173 (73.0%); and type III, 22 (9.3%). Before POEM, peristaltic fragments were present in 23 (9.7%) patients. After POEM the Chicago classification diagnoses were: 112 absent contractility, 42 type I achalasia, 15 type II, 11 type III, 26 ineffective esophageal motility, 18 esophagogastric junction outflow obstruction, 10 fragmented peristalsis, and 3 distal esophageal spasm. Altogether 68 patients (28.7%) had signs of contractile activity, but the contractions newly appeared in 47 patients (47/214, 22.0%). Type II achalasia showed a trend for appearance of contractions (P = 0.097). Logistic regression analysis did not identify any predictors of peristaltic recovery. The post-POEM Eckardt score did not differ between patients with and without contractions nor did the parameters of timed barium esophagogram.ConclusionsMore than 20% of achalasia patients have signs of partial recovery of esophageal peristalsis after POEM. It occurs predominantly in type II achalasia but the clinical relevance seems to be negligible.
| S-EPMC8026367 | biostudies-literature
Project description:Esophageal diverticula are uncommon; however, when present, they can cause symptoms of dysphagia, regurgitation, and chest pain. Based on location and pathophysiological characteristics, they are classified as pulsion- and traction-type diverticula. In the past, the open surgical approach was the only treatment available; however, in the past few decades, transoral incisionless approaches in the form of rigid and flexible endoscopy have gained popularity. Diverticular peroral endoscopic myotomy has emerged as an alternative treatment option. In this paper, we reviewed the role of peroral endoscopic myotomy as a treatment option for different types of esophageal diverticula. Although a safe and effective procedure, this novel submucosal tunneling technique for the treatment of esophageal diverticula requires further validation, and head-to-head comparisons between the different approaches for the treatment of esophageal diverticula are warranted.
| S-EPMC7719426 | biostudies-literature
Project description:Video 1Peroral endoscopic myotomy for a residual Zenker's diverticulum following endoscopic myotomy.
| S-EPMC8755520 | biostudies-literature
Project description: Not available
| S-EPMC7652700 | biostudies-literature
Project description:Background and aimsDefinitive treatment options for refractory dysphagia due to cricopharyngeal bar are limited. We aimed to demonstrate a novel adaptation of peroral endoscopic myotomy to treat this condition (cricopharyngeal peroral endoscopic myotomy [c-POEM]).MethodsThe approach to c-POEM is similar to that in the distal esophagus for the treatment of achalasia. A submucosal injection and overlying mucosal incision are performed, ideally 1.5 to 2 cm upstream of the upper esophageal sphincter, and then a submucosal tunnel is extended beyond the level of the cricopharyngeus. The target muscle is then transected before closure of the mucosotomy.ResultsIn 3 cases of refractory cricopharyngeal bar, c-POEM was successfully performed. Although no major adverse events occurred, significant postprocedural edema at the level of the upper esophageal sphincter prolonged hospitalization in 2 of the 3 patients. After recovery, all patients reported complete resolution of dysphagia and tolerated an unrestricted diet.ConclusionsC-POEM allows reliable and complete muscular division in patients with refractory cricopharyngeal bar who have limited treatment options.
| S-EPMC7426955 | biostudies-literature
Project description:Background and aimsGastric peroral endoscopic myotomy (GPOEM) is a promising treatment for refractory gastroparesis. Initially, endoscopists performed GPOEM along the greater curve of the stomach. We, herein, present a novel modification with a lesser curve approach that offers the advantages of shorter tunnel and possibly better myotomy.MethodsThree patients with refractory gastroparesis underwent GPOEM by use of the lesser curve approach. Two of the patients had a prior GPOEM by the traditional greater curve approach. All procedures were performed with the patient under general anesthesia. The specific tools used for incision, dissection, and myotomy are described. The patients were followed up closely, and the gastroparesis cardinal symptom index (GCSI) was calculated before, and 4 weeks after, the procedure.ResultsThe pyloric ring was exposed very well with the lesser curve approach. The mean procedure time was 48 ± 12 minutes. No immediate or late adverse events were observed. All patients had significant improvement in the GCSI 4 weeks after GPOEM, with resolution of gastroparesis symptoms. The mean follow-up time was 6 months.ConclusionThe lesser curve approach to GPOEM provides an excellent exposure to the pyloric ring and can be used as a primary or a salvage technique for the treatment of refractory gastroparesis.
| S-EPMC6835000 | biostudies-literature