Figure - available from: Clinical and Experimental Gastroenterology
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Stepwise illustration of POEM procedure. (A) Mucosal incision and submucosal injection, (B) creation of submucosal tunnel, (C) distal esophageal circular muscle dissection and myotomy, and (D) closure of mucosal incision using endoscopic clips.
Source publication
Achalasia is a rare esophageal motility disorder characterized by esophageal aperistalsis and impaired relaxation of lower esophageal sphincter. There is no cure for achalasia and all the current treatments are aimed at palliation of symptoms by reducing the lower esophageal sphincter pressure. Currently, laparoscopic Heller myotomy (LHM) with part...
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Achalasia is one of the most common esophageal motility disorders. Typical symptoms include dysphagia, food regurgitation, respiratory symptoms, chest pain, and weight loss. Respiratory obstruction due to tracheal compression by the massively dilated esophagus is a very rare but fatal complication. A 36-year-old male presented with progressive resp...
Background: Laparoscopic Heller myotomy (LHM) is considered the standard surgical approach in patients newly diagnosed with achalasia worldwide. However, proceeding to fundoplication after LHM remains controversial due to the observed postoperative symptoms, including dysphagia and regurgitation. This study was conducted to compare the postoperativ...
A 9-year-old male child diagnosed to have achalasia cardia when he presented with a history of vomiting of undigested food particles with poor weight gain. He underwent lap Heller myotomy and Dor fundoplication. The immediate postoperative period was uneventful. After discharge, he presented with peritonitis and septic shock. On contrast-enhanced c...
Background: Laparoscopic sleeve gastrectomy (LSG) is associated with the long-term development of gastroesophageal reflux disease (GERD). Recent studies on LSG with fundoplication showed a lower rate of postoperative GERD than LSG alone; however, there is a lack of objective instrumental data in the literature. This study aimed to evaluate whether...
Citations
... Achalasia is a rare progressive motility disorder, characterized by esophageal aperistalsis and impaired LES relaxation, leading to increased dysphagia of solids and liquids and regurgitation of indigested contents (77)(78)(79)(80)(81)(82). Its presentation is particular in adult life, and diagnosis in childhood is quite rare. ...
... Current management includes laparoscopic Heller myotomy (LHM), POEM, pneumatic dilatation, and the injection of botulinum toxin. Since its first description in 2010 by Inoue et al., POEM has become an effective and safe procedure worldwide with the advantage of significant lower operation time and a shorter length of stay, and hence, it has replaced LHM as first-line treatment in adults (77,82). ...
... Clinical success rates in adults vary between 82 and 100% with particularly good results in patients with prior failed therapy: a recent meta-analysis indicates a 98% success rate in patients who had failed LHM (77). POEM has now been reported in children. ...
This paper seeks to give a broad overview of pediatric upper gastrointestinal (GI) pathologies that we are now able to treat endoscopically, acquired or congenital, and we hope this delivers the reader an impression of what is increasingly available to pediatric endoscopists and their patients.
High-resolution esophageal manometry (HREM) is a fundamental diagnostic tool in esophagology. Educational tools for this procedure have remained scarce. This quality improvement project aimed to develop an enhanced digital recording about HREM and assess the effect on patient knowledge, anxiety, satisfaction, and procedure abortion rates. The Institute for Healthcare Improvement Model for Improvement and the self-regulation theory guided this project. An interprofessional team was formed. A video recording of the pre-, peri-, and post-HREM care was created. Participants were recruited in the following four cycles: Baseline, Workstation, Manometry, and Home. Questionnaires were collected pre- and postvideo education. The results demonstrated a significant increase in knowledge from 60% to 96% ( p < .001), 58% to 96% ( p < .001), 79% to 96% ( p < .001), and 92% to 97% ( p = .02) and reductions in anxiety from 7.1 to 5.5 ( p = .003), 7.6 to 6.1 ( p = .003), 7.1 to 6.5 ( p < .001), and 6.4 to 6.1 ( p = .03) in all four groups. Almost all (99.5%) participants liked the recorded education and only 2.6% of cases were aborted during the 1-year project implementation period from June 2020 to May 2021. Findings from this project support the positive impact of recorded patient education. An educational recording is standardized and has the potential to be implemented in variable settings.
This article aims to explore details of research, evidence, and key concepts intended for nurses and other healthcare clinicians surrounding the paradigm shift in therapeutic endoscopy relating to the third-space endoscopic procedure, peroral endoscopic myotomy. Although many medical publications detail the procedure, there are no specific guidelines for nurses to reference when caring for the patient undergoing peroral endoscopic myotomy. With scant published resources available to direct nurses distinctly in the delivery of exceptional care to patients undergoing peroral endoscopic myotomy, there is an identified need for collated information to be accessible to all nurses providing perioperative teaching and care. As peroral endoscopic myotomy continues to transpire as a mainstream or preferred standard treatment for patients who suffer from achalasia, relevant education remains to be fully understood and assessed in the nursing arena. By examining nursing considerations for patient care, indications, techniques, and advancements regarding this ever-emergent breakthrough, readers will discover guidance in comprehensive care encompassing patients undergoing the peroral endoscopic myotomy procedure.
Achalasia cardia, type of esophageal dynamic disorder, is a relatively rare primary motor esophageal disease characterized by the functional loss of plexus ganglion cells in the distal esophagus and lower esophageal sphincter. Loss of function of the distal and lower esophageal sphincter ganglion cells is the main cause of achalasia cardia, and is more likely to occur in the elderly. Histological changes in the esophageal mucosa are considered pathogenic; however, studies have found that inflammation and genetic changes at the molecular level may also cause achalasia cardia, resulting in dysphagia, reflux, aspiration, retrosternal pain, and weight loss. Currently, the treatment options for achalasia focus on reducing the resting pressure of the lower esophageal sphincter, helping to empty the esophagus and relieve symptoms. Treatment measures include botulinum toxin injection, inflatable dilation, stent insertion, and surgical myotomy (open or laparoscopic). Surgical procedures are often subject to controversy owing to concerns about safety and effectiveness, particularly in older patients. Herein, we review clinical epidemiological and experimental data to determine the prevalence, pathogenesis, clinical presentation, diagnostic criteria, and treatment options for achalasia to support its clinical management.
Approaches to achalasia include non-operative and operative techniques with Heller Myotomy and Per-Oral Endoscopic Myotomy (POEM) at the forefront of palliative strategies. Given the diverse subtypes and the time-dependent failure pattern for achalasia, there is no standard approach. We elect for a POEM for type III achalasia, poor functional status, hostile abdomen, and salvage after the previous myotomy. A Heller myotomy is elected over a POEM for type II achalasia, presence of diverticulum, and hiatal hernia. As long-term outcomes become available, an optimal customized strategy will become clearer.
