Background
Peroral endoscopic myotomy (POEM) was developed to reduce lower esophageal sphincter
pressure in patients with achalasia. POEM is technically challenging and time consuming.
The creation of an esophageal submucosal tunnel is a major and integral part of the
procedure. Dissection of the submucosal fibers is a lengthy task.
Objective
To present our initial experience with the use of a novel gel with dissecting properties
for facilitating submucosal tunneling during POEM.
Setting
Johns Hopkins Hospital.
Intervention
POEM.
Results
The gastroscope was successfully introduced into the submucosal space in all pigs.
The gel in the submucosal space was easily suctioned through the working channel of
the gastroscope and did not interfere with endoscopic visualization. The esophageal
submucosal tunnel was noted to be already formed upon entry into the submucosal space
in all 5 pigs. Esophageal submucosal dissection was not required in any case. “Auto-tunneling”
by the dissecting gel stopped at the level of the lower esophageal sphincter. Further
tunneling into the gastric cardia was needed in all pigs. The average procedure (including
myotomy) time was 28 minutes.
Limitations
Animal experiments.
Conclusion
Gel consistently resulted in efficient auto-tunneling without any complications. This
gel has the potential to revolutionize POEM and endoscopic submucosal dissection if
its safety and efficacy are replicated in other animal studies and subsequently in
human trials.
Abbreviations:
POEM (peroral endoscopic myotomy), GEJ (gastroesophageal junction)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis.Ann Surg. 2009; 249: 45-57
- 2011 update on esophageal achalasia.World J Gastroenterol. 2012; 18: 1573-1578
- How I do it: per-oral endoscopic myotomy (POEM).J Gastrointest Surg. 2012; 16: 1251-1255
- Peroral endoscopic myotomy (POEM) for esophageal achalasia.Endoscopy. 2010; 42: 265-271
- Peroral endoscopic myotomy (POEM) for oesophageal achalasia: preliminary results in humans.Dig Liver Dis. 2012; 44: 827-832
- Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study.Am J Gastroenterol. 2012; 107: 411-417
- Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases).Surg Endosc. 2012; 26: 3267-3272
- Successful treatment of diffuse esophageal spasm by peroral endoscopic myotomy.Gastrointest Endosc. 2012 Apr 4; (Epub)
- Peroral endoscopic myotomy for esophageal achalasia: technique, indication, and outcomes.Thorac Surg Clin. 2011; 21: 519-525
- Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity.Gastrointest Endosc. 2004; 60: 114-117
- NOTES: current status and new horizons.Gastroenterology. 2012; 142: 704-710 e1
- Critical analysis of hot topics in NOTES.Nat Rev Gastroenterol Hepatol. 2011; 8: 565-572
- Submucosal endoscopy with mucosal flap safety valve.Gastrointest Endosc. 2007; 65: 688-694
- Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia.Endoscopy. 2007; 39: 761-764
Article info
Publication history
Accepted:
September 10,
2012
Received:
August 3,
2012
Footnotes
DISCLOSURE: M.A. Khashab and P.I. Okolo are consultants for Boston Scientific. P. Pasricha and A. Kalloo are founding members, equity holders, and consultants for Apollo Endosurgery. No other financial relationships relevant to this publication were disclosed.
Identification
Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
