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Jawaid S, Draganov PV, Aihara H, Khashab MA, Yang D. Pilot prospective study on formal training in per-oral endoscopic myotomy (POEM) during advanced endoscopy fellowship. Endosc Int Open 2021; 9:E1890-E1899. [PMID: 34917458 PMCID: PMC8671003 DOI: 10.1055/a-1610-8962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/31/2021] [Indexed: 11/20/2022] Open
Abstract
Background and study aims Gastroenterology societies have recently proposed core curricula for training in per-oral endoscopic myotomy (POEM) based on expert opinion with limited data on its applicability for advanced endoscopy fellowship (AEF) trainees. We prospectively evaluated the feasibility of a structured POEM training curriculum during a dedicated AEF and the trainee's performance during independent practice. Methods This was a single-center prospective study evaluating a trainee's performance of POEM using a structured assessment tool (POEMAT) to assess core cognitive and technical skills. The trainee's performance was then prospectively assessed during the first 12 months of independent practice. Results The trainee, who had not prior background in submucosal endoscopy, first observed 22 POEM cases followed by 35 hands-on procedures during his advanced endoscopy fellowship. Based on the POEMAT, submucosal entry and mucosal incision closure were the most challenging technical aspects, while cognitive skills were uniformly attained early in training. Overall, the trainee was able to cross the threshold for competence in his POEMAT performance score in 15 of his last 18 cases (83.3 %). The trainee performed 16 POEMs (baseline mean Eckardt 7.2) in his first 12 months of independent practice. Mean procedural time was 79.8 minutes (interquartile range: 67-94 minutes minutes) with no adverse events. Clinical success (Eckardt score < 3) was achieved in 100 % of the cases at a median follow-up of 20 weeks. Conclusions Results from this pilot study support the adoptability of the recently proposed core curricula for POEM training within the context of a dedicated AEF and provide a potential blueprint for future studies of performance in POEM among trainees.
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Affiliation(s)
- Salmaan Jawaid
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States,Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, United States
| | - Peter V. Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
| | - Hiroyuki Aihara
- Division of Gastroenterology and Hepatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, United States
| | - Dennis Yang
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
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Peñaloza-Ramírez A, Suárez-Correa J, Báez-Blanco J, Sabogal-Gómez C, Kuan-Casas H, Sánchez-Pignalosa C, Aponte-Ordóñez P. In vivo experience with peroral endoscopic myotomy: An essential activity for developing the technique in humans. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2018. [DOI: 10.1016/j.rgmxen.2017.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Peñaloza-Ramírez A, Suárez-Correa J, Báez-Blanco J, Sabogal-Gómez C, Kuan-Casas H, Sánchez-Pignalosa C, Aponte-Ordóñez P. In vivo experience with peroral endoscopic myotomy: An essential activity for developing the technique in humans. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017; 83:86-90. [PMID: 28711287 DOI: 10.1016/j.rgmx.2017.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Achalasia is the most widely studied esophageal motility disorder. No treatment has achieved completely satisfactory results. The laparoscopic Heller esophagomyotomy is currently the most accepted technique. With the advent of minimally invasive surgery, the appearance of peroral endoscopic myotomy (POEM) has promising results. The primary aim of our study was to perform peroral endoscopic esophagomyotomy in animal experimentation models to perfect the technique and later apply it to humans. The secondary aims were to evaluate the intraoperative and postoperative complications and to describe the anatomopathologic findings. MATERIALS AND METHODS An experimental study was conducted on 8 live porcine models that were followed for 30 days to identify postoperative complications. Necropsy was then performed to evaluate the histopathologic findings. The international requirements and regulations for animal experimentation were met. RESULTS The technique was carried out in all the models. There was one intraoperative death. Pneumothorax was observed in 50% of the units in experimentation and subcutaneous cervical emphysema in 75%, with no significant clinical repercussions. Histologic muscle layer (myotomy) involvement was above the gastroesophageal junction in 87% of the cases and below it in 25%. CONCLUSION Peroral endoscopic esophagomyotomy is a feasible, albeit complex, procedure that requires advanced training, and thus should be performed in highly specialized centers. Specific skills in advanced therapeutic endoscopic procedures of this type must continue to be developed through continuing education (ideally in in vivo models), to then be performed on humans.
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Affiliation(s)
- A Peñaloza-Ramírez
- Programa de Especialización en Gastroenterología y Endoscopia Digestiva, Fundación Universitaria de Ciencias de la Salud-Sociedad de Cirugía de Bogotá, Servicio de Gastroenterología y Endoscopia Digestiva, Hospital de San José, Bogotá, Colombia.
| | - J Suárez-Correa
- Programa de Especialización en Gastroenterología y Endoscopia Digestiva, Fundación Universitaria de Ciencias de la Salud-Sociedad de Cirugía de Bogotá, Servicio de Gastroenterología y Endoscopia Digestiva, Hospital de San José, Bogotá, Colombia
| | - J Báez-Blanco
- Programa de Especialización en Gastroenterología y Endoscopia Digestiva, Fundación Universitaria de Ciencias de la Salud-Sociedad de Cirugía de Bogotá, Servicio de Gastroenterología y Endoscopia Digestiva, Hospital de San José, Bogotá, Colombia
| | - C Sabogal-Gómez
- Programa de Especialización en Gastroenterología y Endoscopia Digestiva, Fundación Universitaria de Ciencias de la Salud-Sociedad de Cirugía de Bogotá, Servicio de Gastroenterología y Endoscopia Digestiva, Hospital de San José, Bogotá, Colombia
| | - H Kuan-Casas
- Programa de Especialización en Gastroenterología y Endoscopia Digestiva, Fundación Universitaria de Ciencias de la Salud-Sociedad de Cirugía de Bogotá, Servicio de Gastroenterología y Endoscopia Digestiva, Hospital de San José, Bogotá, Colombia
| | - C Sánchez-Pignalosa
- Programa de Especialización en Gastroenterología y Endoscopia Digestiva, Fundación Universitaria de Ciencias de la Salud-Sociedad de Cirugía de Bogotá, Servicio de Gastroenterología y Endoscopia Digestiva, Hospital de San José, Bogotá, Colombia
| | - P Aponte-Ordóñez
- Programa de Especialización en Gastroenterología y Endoscopia Digestiva, Fundación Universitaria de Ciencias de la Salud-Sociedad de Cirugía de Bogotá, Servicio de Gastroenterología y Endoscopia Digestiva, Hospital de San José, Bogotá, Colombia
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Tang X, Ren Y, Wei Z, Zhou J, Deng Z, Chen Z, Jiang B, Gong W. Factors predicting the technical difficulty of peroral endoscopic myotomy for achalasia. Surg Endosc 2015; 30:3774-82. [PMID: 26659228 DOI: 10.1007/s00464-015-4673-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/07/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Peroral endoscopic myotomy (POEM) has been described as a novel treatment for esophageal achalasia. Owing to its technical difficulty, POEM is not widely performed. This study was aimed to prospectively assess the factor predicting technical difficulty of POEM in a single center with large volume cases. METHODS A total of 105 cases of achalasia treated by POEM from April 2011 to September 2014 were analyzed. Difficult cases of POEM were defined as procedure time ≥90 min and occurrence of adverse events, including mucosal perforation, pneumothorax, and major bleeding. Univariate and multivariate logistic regression analyses were performed to assess the predictive factors of difficult POEM. RESULTS POEM was successfully completed in all the patients, and no one was converted to laparoscopy. The number of cases with procedure time ≥90 min was 17. Mucosal perforations occurred in six (5.7 %) patients during submucosal tunnel creation, major bleeding occurred in seven (6.7 %) patients, and pneumothorax occurred in six (5.7 %) patients immediately after procedure. All the complications were managed conservatively. No other intraoperative and immediate postoperative complications, including infections and pneumoperitoneum, occurred. Multivariate analysis showed that early period (odds ratio [OR] 4.173, 95 % confidence interval [95 % CI] 1.36-6.829, P = 0.023) and triangular tip knife ([OR] 6.712, [95 % CI] 1.479-30.460, P = 0.014) were independent factors associated with technical difficulty regarding longer procedure time (procedure time ≥90 min). CONCLUSION POEM is safe for the treatment of esophageal achalasia. Triangular tip knife and early period were independent risk factors for longer procedural time.
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Affiliation(s)
- Xiaowei Tang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou North Ave, Guangzhou, 510515, China.,Department of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Beijing, China
| | - Yutang Ren
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Beijing, China
| | - Zhengjie Wei
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Beijing, China
| | - Jieqiong Zhou
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou North Ave, Guangzhou, 510515, China.,Department of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Beijing, China
| | - Zhiliang Deng
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou North Ave, Guangzhou, 510515, China
| | - Zhenyu Chen
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou North Ave, Guangzhou, 510515, China
| | - Bo Jiang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou North Ave, Guangzhou, 510515, China.,Department of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Beijing, China
| | - Wei Gong
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou North Ave, Guangzhou, 510515, China.
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Peroral endoscopic myotomy for treatment of achalasia in children and adolescents. J Pediatr Surg 2015; 50:201-5. [PMID: 25598123 DOI: 10.1016/j.jpedsurg.2014.10.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 09/08/2014] [Accepted: 10/01/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Peroral endoscopic myotomy (POEM) is a novel endoscopic technique for treatment of achalasia (AC) and has shown exciting results in adults. However, little is known about the safety and efficacy of POEM in children and adolescents. Herein we report our preliminary results of POEM for children and adolescents with AC. METHODS POEM was performed in 9 consecutive patients with AC, whose age ranged from 10 to 17years. After submucosal injection, a submucosal tunnel was created. Endoscopic myotomy of muscle bundles was then achieved under direct vision. The mucosal entry was closed by several clips. A validated clinical symptom score (Eckardt score), LES pressure, esophageal diameters and procedure-related complications were used to evaluate the outcomes. RESULTS All 9 patients underwent POEM successfully. Mean operation time was 56.7minutes. Mean myotomy length was 8.3cm. Among them, 4 patients underwent circular myotomy and 5 underwent full-thickness myotomy. Symptoms remitted in all of the cases during a follow-up of 3-30months, Eckardt score was significantly reduced (preoperation vs postoperation, 7.0±1.9 vs 0.8±0.8, P<0.05). Mean LES pressure decreased from 26.8mm Hg to 9.1mm Hg. Mean diameter of esophagus was dramatically decreased (preoperation vs postoperation, 50.6±4.9mm vs 29.6±3.7mm, P<0.05). No serious complications related to POEM were encountered. CONCLUSIONS Our initial experience suggests that POEM is a safe and effective method for treatment of achalasia in children and adolescents. Further evaluation and long-term data are mandatory for a more confirmed conclusion.
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Kim EY, Kwon KA, Choi IJ, Ryu JK, Hahm KB. International digestive endoscopy network 2014: turnpike to the future. Clin Endosc 2014; 47:371-82. [PMID: 25324994 PMCID: PMC4198551 DOI: 10.5946/ce.2014.47.5.371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 09/10/2014] [Indexed: 12/13/2022] Open
Abstract
Social networks are useful in the study of relationships between individuals or entire populations, and the ties through which any given social unit connects. Those represent the convergence of the various social contacts of that unit. Consequently, the term "social networking service" (SNS) became extremely familiar. Similar to familiar SNSs, International Digestive Endoscopy Network (IDEN) 2014 was based on an international network composed of an impressive 2-day scientific program dealing with a variety of topics for gastrointestinal (GI) diseases, which connects physicians and researchers from all over the world. The scientific programs included live endoscopic demonstrations and provided cutting-edge information and practice tips as well as the latest advances concerning upper GI, lower GI, and pancreatobiliary endoscopy. IDEN 2014 featured American Society for Gastrointestinal Endoscopy-Korean Society of Gastrointestinal Endoscopy (ASGE-KSGE)-joint sessions prepared through cooperation between ASGE and KSGE. Furthermore, IDEN 2014 provided a special program for young scientists called the 'Asian Young Endoscopist Award Forum' to foster networks, with many young endoscopists from Asian countries taking an active interest and participation.
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Affiliation(s)
- Eun Young Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Kwang An Kwon
- Department of Gastroenterology, Gachon University Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Il Ju Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Ji Kon Ryu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Baik Hahm
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Tan YY, Liu DL, Zhang J, Li CJ, Duan TY, Zhou JF, Wang XH, Huo JR. Peroral endoscopic myotomy for achalasia: A comparative study of simple longitudinal mucosal incision and modified incision. Shijie Huaren Xiaohua Zazhi 2014; 22:4129-4134. [DOI: 10.11569/wcjd.v22.i27.4129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the safety and efficacy of simple longitudinal mucosal incision with modified incision during peroral endoscopic myotomy (POEM) for achalasia (AC).
METHODS: A total of 75 patients with AC were treated by POEM between January 2013 and April 2014 at our hospital. According to the method of mucosal incision, patients were assigned to two groups, namely, a modified incision group and a simple longitudinal mucosal incision group. Symptom relief, procedure-related parameters, manometry outcome, complications and follow-up data were collected and compared between the two groups.
RESULTS: POEM was successful in all the 75 patients, of whom 26 received a simple longitudinal mucosal incision and 49 received a modified incision. Eckardt score and lower esophageal sphincter pressure (LESP) decreased significantly during a median follow-up of eight months (preoperative vs postoperative: 6.4 vs 0.5, 31.3 mmHg vs 6.49 mmHg, P < 0.01). Treatment success was achieved in 96.2% (25/26) of patients in the simple longitudinal mucosal incision group and in 98.0% (48/49) of patients in the modified incision group. No recurrence was noted. There was no significant difference in mean operative time, pre and post-treatment Eckardt's score, lower esophageal sphincter pressure, esophageal diameter, or recurrence rate between the two groups. However, patients in the modified incision group were less likely to develop gas-related complications (P < 0.05).
CONCLUSION: Short-term efficacy is comparable between the two groups, and modified incision can reduce the rate of gas-related complications.
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Peroral endoscopic myotomy for the treatment of achalasia: an analysis. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2013; 2013:389596. [PMID: 24282373 PMCID: PMC3825053 DOI: 10.1155/2013/389596] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 09/13/2013] [Indexed: 02/07/2023]
Abstract
Achalasia is a motility disorder of the esophagus, characterized by aperistalsis of the esophageal body and incomplete relaxation of the lower esophageal sphincter (LES). Treatment of achalasia is currently aimed at decreasing the resting pressure in the LES. Peroral endoscopic myotomy (POEM) is an emerging novel endoscopic procedure for the treatment of achalasia with initial data suggesting an acceptable safety profile, excellent short-term symptom resolution, low incidence of postprocedural gastroesophageal reflux (GER), and improvement in manometric outcomes. Further prospective randomized trials are required to evaluate the long-term effectiveness of this promising technique compared to other treatment modalities for achalasia. In this review we outline the technical aspects of POEM, summarize the available data on safety and outcomes, and suggest future directions for further advancement of this minimally invasive approach for the treatment of achalasia.
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Hong SJ. Peroral endoscopic myotomy in a porcine model: a step to achalasia patients. Clin Endosc 2013; 46:1-2. [PMID: 23424710 PMCID: PMC3572343 DOI: 10.5946/ce.2013.46.1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 01/05/2013] [Accepted: 01/05/2013] [Indexed: 12/13/2022] Open
Affiliation(s)
- Su Jin Hong
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
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