Journal article
Per oral endoscopic myotomy: early experience and safety of a multispecialty approach
Surgical endoscopy, Vol.32(7), pp.3357-3363
07/2018
DOI: 10.1007/s00464-018-6056-9
PMID: 29349541
Abstract
Per oral endoscopic myotomy (POEM) has gained increasing popularity for treating achalasia. A multidisciplinary approach may allow safe and early adoption of POEM into clinical practice.
We performed a retrospective review of our initial POEM cases. All procedures were performed by a team of interventional gastroenterologist and thoracic surgeon. We analyzed demographics, comorbidities, achalasia subtypes, length of hospital stay, duration of surgery, morbidity, mortality, length of myotomy, preoperative and postoperative Eckardt scores.
Thirty-one consecutive patients underwent POEM during the 24-month period from January 2014 to December 2015. Eighteen patients (58%) had prior non-operative interventions. Average duration of follow-up was 9.6 months. Seventeen patients (66.8%) had follow-up of 12 months and longer. Average preoperative Eckardt score was 6.3 (3-10), median 6. Average postoperative Eckardt score was 1.4 (0-8), median 1, in 1 month and an average 2.2, median 1, in 1 year. Patients with type III achalasia were most refractory to treatment, while patients with type II had the best results. Average LOS was 1.3 days (1-5), median 1 day. Average DOS was 106 min (60-148), median 106. Average LOM was 13 cm (10-15), with median of 13 cm. We had one 30-day mortality secondary to coronary artery disease. Four patients had prior Heller myotomies and underwent a posterior myotomy during POEM, with outcomes similar to patients with no prior myotomy.
We demonstrated safety and efficiency of a multispecialty approach for achalasia with POEM with a low rate of complications.
Details
- Title: Subtitle
- Per oral endoscopic myotomy: early experience and safety of a multispecialty approach
- Creators
- Evgeny V Arshava - Division of Cardiothoracic Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USARaffaele J Marchigiani - Division of Cardiothoracic Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USAHenning Gerke - Division of Gastroenterology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USARami El Abiad - Division of Gastroenterology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USARonald J Weigel - Division of Cardiothoracic Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USAKalpaj R Parekh - Division of Cardiothoracic Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USAJohn Keech - Division of Cardiothoracic Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA. john-keech@uiowa.edu
- Resource Type
- Journal article
- Publication Details
- Surgical endoscopy, Vol.32(7), pp.3357-3363
- Publisher
- Germany
- DOI
- 10.1007/s00464-018-6056-9
- PMID
- 29349541
- ISSN
- 0930-2794
- eISSN
- 1432-2218
- Language
- English
- Date published
- 07/2018
- Academic Unit
- Molecular Physiology and Biophysics; Anatomy and Cell Biology; Gastroenterology and Hepatology; Surgery; Biochemistry and Molecular Biology; Cardiothoracic Surgery; Internal Medicine
- Record Identifier
- 9984025276202771
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