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December 12, 2019

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A prospective analysis of GERD after POEM on anterior myotomy

October 3, 2015

Brand new POEM study: A prospective analysis of GERD after POEM on anterior myotomy

Please read carefully. Many points here exemplify the conventional medical thought and reporting processes.


Positive take aways: 

1. Notice that these patients were tested pre-operatively quite thoroughly: Eckhart score, manometry, endoscopy, barium swallow, and computed tomography. If your doctor doesn't understand this, get a new one!

Look at my symptom survey in my book; it is much more complete than the Eckhart score. And I do not think the massive radiation exposure from the CT is worth doing. We get enough radiation from all the barium swallows! If your doctor wants a CT, ask why.


2. Tables 1 and 2 are excellent charts. I am making changes in the diagnostic protocol worksheet in my book based on these charts. Very important: notice how they added another "Type" category which makes the distinction by shape of the esophagus: straight or sigmoid.


3. Read the description of the surgical procedure itself. Excellent!


4. Interesting description of "antirelfux" mechanisms: inner circular muscles, oblique muscle, crus of diaphragm, and the phrenoesophageal ligament. They also recommend "extended gastric myotomy (approximately 2–3 cm)." 


 If you are considering POEM, discuss these particulars with your surgeon. I am happy to explain these one on one in more detail. This is VERY IMPORTANT! If your surgeon does not understand these or does not wish to discuss them, get a new surgeon!


Not so good take aways:

1. Follow-up is only 3 months.


2. The Conclusion states: "POEM is effective and safe in treating achalasia, with no occurrence of clinically significant refractory GERD." 


This is patently false and the statistics in the study prove that fact!


3. There were 105 patients who received POEM and only 70 were followed. When making statements which appear to be fact, it is unconscionable to not qualify them with this!


4. " is superior to other therapeutic methods in that it has a curative effect with consistent outcomes...." 

"...POEM is known to have a curative effect, similar to the Heller myotomy."


Curative? REALLY? Anyone else want to comment on that! There is no surgery for Achalasia that is "curative!" The surgery does not address the disease process! Curative is used many times in this paper. WOW! What arrogance!


5. "decreasing the pressure at the LES is the only valid therapeutic approach to eliminate or reduce these symptoms [reflux esophagitis]...." Really? I don't agree! Once again, surgeons only look at surgical solutions. Read my book!


After reading this paper, I am more convinced than ever that picking from only a few skilled POEM surgeons is the only way to go if you are considering POEM. Ask about post-operative reflux and how they plan to address that.


And make your surgical decision wisely. Do you even need it? Again, read my book and I am happy to help anyone privately.


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