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December 12, 2019

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POEM Update

December 12, 2019

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The POEM papers keep coming....

October 24, 2015

Peroral endoscopic full-thickness myotomy for the treatment of sigmoid-type achalasia: outcomes with a minimum follow-up of 12 months

This study followed 23 sigmoid-type achalasia patients after POEM for 18 months.  The surgery took an average of 67.6 minutes.

 

I always find comments like this amusing:

"Overall treatment success was achieved in 95.6% of the patients (22/23), and morphological improvement was observed in 95% (19/20) of the patients."

But... "In 10 patients (43.5%) complications were encountered, including gas-related complications, mucosal perforation, and reflux esophagitis."

 

At least the conclusion was honest: "Yet, further experiences and long-term results are warranted."

 

Evaluation of the need for routine esophagram after peroral endoscopic myotomy (POEM)

"Most centers perform a routine esophagram on postoperative day (POD) #1 to rule esophageal perforation and leaks. In this study, we sought to determine the clinical utility of routine contrast studies post-POEM."

 

"Overall, 56 patients had abnormal studies. POD #1 esophagram demonstrated a sensitivity of 100 % and specificity of 45 % in identifying clinically significant complications.

 

CONCLUSIONS: In this series, we found routine esophagram to have a high sensitivity but a very low specificity in detecting clinically significant complications. Routine esophagram after POEM may not be necessary."

 

This paper's conclusion is a bit puzzling given the number of post POEM abnormal studies. Wouldn't you want to check your work? I will take the radiation exposure to make sure all is OK.

 

Intraoperative measurement of esophagogastric junction cross-sectional area by impedance planimetry correlates with clinical outcomes of peroral endoscopic myotomy for achalasia: a multicenter study

Make the EGJ junction larger and you get a better outcome. OK, no big news on this one.

"Of the 63 treated patients, 50 had good and 13 had poor clinical response." Not great....

 

​Remember, surgery does not address the root cause of Achalasia.

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