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Facciorusso A, Ramai D, Ichkhanian Y, Yadlapati R, Annese V, Wani S, Khashab MA. Peroral Endoscopic Myotomy for the Treatment of Esophageal Diverticula: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2022; 56:853-862. [PMID: 34608024 PMCID: PMC8977395 DOI: 10.1097/mcg.0000000000001622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is limited evidence on the efficacy of peroral endoscopic myotomy (POEM) in patients with esophageal diverticula. AIMS This meta-analysis aimed to assess the efficacy and safety profile of POEM in patients with Zenker (ZD) and epiphrenic diverticula. METHODS With a literature search through August 2020, we identified 12 studies (300 patients) assessing POEM in patients with esophageal diverticula. The primary outcome was treatment success. Results were expressed as pooled rates and 95% confidence intervals. RESULTS Pooled rate of technical success was 95.9% (93.4%-98.3%) in ZD patients and 95.1% (88.8%-100%) in patients with epiphrenic diverticula. Pooled rate of treatment success was similar for ZD (90.6%, 87.1%-94.1%) and epiphrenic diverticula (94.2%, 87.3%-100%). Rates of treatment success were maintained at 1 year (90%, 86.4%-97.4%) and 2 years (89.6%, 82.2%-96.9%) in ZD patients. Pooled rate of symptom recurrence was 2.6% (0.9%-4.4%) in ZD patients and 0% in patients with epiphrenic diverticula. Pooled rates of adverse events and severe adverse events were 10.6% (4.6%-16.6%) and 3.5% (0%-7.4%) in ZD and 8.4% (0%-16.8%) and 8.4% (0%-16.8%) in epiphrenic diverticula, respectively. CONCLUSION POEM represents an effective and safe therapy for the treatment of esophageal diverticula.
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Affiliation(s)
| | - Daryl Ramai
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore
| | - Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Vito Annese
- Valiant Clinic & American Hospital, Dubai, United Arab Emirates
| | - Sachin Wani
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore
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Abstract
For more than a decade, per-oral endoscopic myotomy (POEM) has been performed for the treatment of achalasia and other dysmotilities of the esophagus. POEM has become an accepted alternative to Heller myotomy, a salvation technique for patients not responding to Heller myotomy and the favorite intervention for diffuse esophageal spasm and jackhammer esophagus. POEM paved the way for endoscopic pyloromyotomy, Zenker's diverticulum myotomy, and submucosal tunneling with endoscopic resection. This review will cover the technique and the most current literature of this revolutionary third space technique.
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Chavan R, Nabi Z, Reddy DN. Adverse events associated with third space endoscopy: Diagnosis and management. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii200010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Radhika Chavan
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Zaheer Nabi
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Tan Y, Li C, Yan J, Long L, Huo J, Liu D. Difficult peroral endoscopic myotomy: definition and management strategies. Expert Rev Gastroenterol Hepatol 2019; 13:933-942. [PMID: 31566998 DOI: 10.1080/17474124.2019.1674648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Peroral endoscopic myotomy (POEM) has been established as an alternative endoscopic method for the treatment of achalasia, and several studies have confirmed its relatively long-term efficacy. Although most of the POEM procedures can be smoothly completed, technical difficulties do arise during the treatment of some patients, which may lead to prolonged procedure duration, increased procedure-related complications, or even aborted POEM.Area covered: In the present review, we provide a comprehensive review of difficult POEM, focusing on its definition, risk factors, and intraoperative management strategies. The present review is expected to provide tips for not so experienced operators who perform POEM.Expert commentary: Submucosal fibrosis and sigmoid-type esophagus are associated with difficult POEM. Sometimes, the following may also be associated with difficult POEM: previous endoscopic or surgical treatments, spastic esophageal disorders (type III achalasia, distal esophageal spasm, and hypercontractile esophagus), achalasia with diverticulum or situs inversus. For operators who begin to perform POEM, I suggest an exclusion of patients with severe submucosal fibrosis or sigmoid-type esophagus, and begin to perform POEM for these patients when they have completed at least 50 cases of 'easy POEM' and the proposed management strategies may be helpful.
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Affiliation(s)
- Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chen Li
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jin Yan
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Limin Long
- Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jirong Huo
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Wang Y, Liu S, Lou S, Zhang W, Cai H, Chen X. Application of optical coherence tomography in clinical diagnosis. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:995-1006. [PMID: 31594279 PMCID: PMC7029333 DOI: 10.3233/xst-190559] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Optical coherence tomography (OCT) is a non-invasive diagnosing tool used in clinics. Due to its high resolution (<10um), it is appropriate for the early detection of tiny infections. It has been widely used in diagnosis and treatment of diseases, evaluation of therapeutic efficacy, and monitoring of various physiological and pathological processes. OBJECTIVE To systemically review literature to summarize the clinic application of OCT in recent years. METHODS For clinic applications that OCT has been applied, we selected studies that describe the most relevant works. The discussion included: 1) which tissue could be used in the OCT detection, 2) which character of different tissue could be used as diagnosing criteria, 3) which diseases and pathological process have been diagnosed or monitored using OCT imaging, and 4) the recent development of clinic OCT diagnosing. RESULTS The literature showed that the OCT had been listed as a routine test choice for ophthalmic diseases, while the first commercial product for cardiovascular OCT detection had gotten clearance. Meanwhile, as the development of commercial benchtop OCT equipment and tiny fiber probe, the commercial application of OCT in dermatology, dentistry, gastroenterology and urology also had great potential in the near future. CONCLUSIONS The analysis and discussions showed that OCT, as an optical diagnosing method, has been used successfully in many clinical fields, and has the potential to be a standard inspection method in several clinic fields, such as dermatology, dentistry and cardiovascular.
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Affiliation(s)
- Yi Wang
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
- Key Laboratory of Opto-Electronics Information Technology, Tianjin University, Tianjin, China
- Ministry of Education, China
- Corresponding author: Yi Wang, School of Precision Instrument and Opto-Electronics Engineering, Tianjin
University, China, Key Laboratory of Opto-Electronics Information Technology, Tianjin University, Ministry of
Education, Tianjin, 300072, China. Tel./Fax: +86 22 27404535; E-mail:
| | - Shanshan Liu
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
- Key Laboratory of Opto-Electronics Information Technology, Tianjin University, Tianjin, China
- Ministry of Education, China
| | - Shiliang Lou
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
- Key Laboratory of Opto-Electronics Information Technology, Tianjin University, Tianjin, China
- Ministry of Education, China
| | - Weiqian Zhang
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
- Key Laboratory of Opto-Electronics Information Technology, Tianjin University, Tianjin, China
- Ministry of Education, China
| | - Huaiyu Cai
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
- Key Laboratory of Opto-Electronics Information Technology, Tianjin University, Tianjin, China
- Ministry of Education, China
| | - Xiaodong Chen
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
- Key Laboratory of Opto-Electronics Information Technology, Tianjin University, Tianjin, China
- Ministry of Education, China
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Nabi Z, Reddy DN, Ramchandani M. Adverse events during and after per-oral endoscopic myotomy: prevention, diagnosis, and management. Gastrointest Endosc 2018; 87:4-17. [PMID: 28987545 DOI: 10.1016/j.gie.2017.09.029] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/20/2017] [Indexed: 02/08/2023]
Abstract
Per-oral endoscopic myotomy (POEM) has surfaced as an effective endoscopic treatment modality for achalasia cardia (AC). Promising results in short- and mid-term follow-up studies have increased the use of POEM for the management of AC. POEM can be safely performed in an endoscopy suit, and major adverse events (AEs) are uncommon. AEs encountered during POEM or during the perioperative period principally include insufflation-related AEs, mucosal injuries, bleeding, pain, and aspiration pneumonia. Most insufflation-related AEs do not require an active intervention and therefore should not be considered as AEs in the true sense. When management of AEs is required, most intraoperative AEs can be managed at the same time without untoward consequences. Occurrences of AEs lessen after completion of the learning curve. However, experience alone does not ensure "zero" incidence of AEs, and early recognition remains essential. Postoperative AEs, like leaks, delayed bleeding, and delayed mucosal perforations, may pose special challenges for diagnosis and management. There is no standardized classification system for grading the severity of AEs associated with POEM, resulting in wide variation in their reported occurrences. Uniform reporting of AEs is not only crucial to comprehensively analyze the safety of POEM but also for comparison with other established treatment modalities like Heller's myotomy. GERD is an important long-term AE after POEM. Unlike the perioperative AEs, little is known regarding the intraoperative or patient-related factors that influence the occurrence of post-POEM GERD. Large prospective studies with long-term follow-up are required to determine the procedural factors associated with GERD after POEM.
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Affiliation(s)
- Zaheer Nabi
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mohan Ramchandani
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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