International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video)

Mouen A. Khashab; Ahmed A. Messallam; Manabu Onimaru; Ezra N. Teitelbaum; Michael B. Ujiki; Matthew E. Gitelis; Rani J. Modayil; Eric S. Hungness; Stavros N. Stavropoulos; Mohamad H. El Zein; Hironari Shiwaku; Rastislav Kunda; Alessandro Repici; Hitomi Minami; Philip W. Chiu; Jeffrey Ponsky; Vivek Kumbhari; Payal Saxena; Amit P. Maydeo; Haruhiro Inoue

doi:10.1016/j.gie.2014.10.011

International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video)

Mouen A. Khashab, Ahmed A. Messallam, Manabu Onimaru, Ezra N. Teitelbaum, Michael B. Ujiki, Matthew E. Gitelis, Rani J. Modayil, Eric S. Hungness, Stavros N. Stavropoulos, Mohamad H. El Zein, Hironari Shiwaku, Rastislav Kunda, Alessandro Repici, Hitomi Minami, Philip W. Chiu, Jeffrey Ponsky, Vivek Kumbhari, Payal Saxena, Amit P. Maydeo, Haruhiro Inoue

Gastroenterology and Hepatology

Research output: Contribution to journal › Article › peer-review

Abstract

Background Limited data exist on the use of peroral endoscopic myotomy (POEM) for therapy of spastic esophageal disorders (SEDs). Objective To study the efficacy and safety of POEM for the treatment of patients with diffuse esophageal spasm, jackhammer esophagus, or type III (spastic) achalasia. Design Retrospective study. Setting International, multicenter, academic institutions. Patients All patients who underwent POEM for treatment of SEDs refractory to medical therapy at 11 centers were included. Interventions POEM. Main Outcome Measurements Eckardt score and adverse events. Results A total of 73 patients underwent POEM for treatment of SEDs (diffuse esophageal spasm 9, jackhammer esophagus 10, spastic achalasia 54). POEM was successfully completed in all patients, with a mean procedural time of 118 minutes. The mean length of the submucosal tunnel was 19 cm, and the mean myotomy length was 16 cm. A total of 8 adverse events (11%) occurred, with 5 rated as mild, 3 moderate, and 0 severe. The mean length of hospital stay was 3.4 days. There was a significant decrease in Eckardt scores after POEM (6.71 vs 1.13; P =.0001). Overall, clinical response was observed in 93% of patients during a mean follow-up of 234 days. Chest pain significantly improved in 87% of patients who reported chest pain before POEM. Repeat manometry after POEM was available in 44 patients and showed resolution of initial manometric abnormalities in all cases. Limitations Retrospective design and selection bias. Conclusion POEM offers a logical therapeutic modality for patients with SEDs refractory to medical therapy. Results from this international study suggest POEM as an effective and safe platform for these patients.

Original language	English (US)
Pages (from-to)	1170-1177
Number of pages	8
Journal	Gastrointestinal endoscopy
Volume	81
Issue number	5
DOIs	https://doi.org/10.1016/j.gie.2014.10.011
State	Published - May 1 2015

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Gastroenterology

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Khashab, M. A., Messallam, A. A., Onimaru, M., Teitelbaum, E. N., Ujiki, M. B., Gitelis, M. E., Modayil, R. J., Hungness, E. S., Stavropoulos, S. N., El Zein, M. H., Shiwaku, H., Kunda, R., Repici, A., Minami, H., Chiu, P. W., Ponsky, J., Kumbhari, V., Saxena, P., Maydeo, A. P., & Inoue, H. (2015). International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video). Gastrointestinal endoscopy, 81(5), 1170-1177. https://doi.org/10.1016/j.gie.2014.10.011

Khashab, MA, Messallam, AA, Onimaru, M, Teitelbaum, EN, Ujiki, MB, Gitelis, ME, Modayil, RJ, Hungness, ES, Stavropoulos, SN, El Zein, MH, Shiwaku, H, Kunda, R, Repici, A, Minami, H, Chiu, PW, Ponsky, J, Kumbhari, V, Saxena, P, Maydeo, AP & Inoue, H 2015, 'International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video)', Gastrointestinal endoscopy, vol. 81, no. 5, pp. 1170-1177. https://doi.org/10.1016/j.gie.2014.10.011

@article{b41f4c5dba1645fbb07b883fcfc9ed9b,

title = "International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video)",

abstract = "Background Limited data exist on the use of peroral endoscopic myotomy (POEM) for therapy of spastic esophageal disorders (SEDs). Objective To study the efficacy and safety of POEM for the treatment of patients with diffuse esophageal spasm, jackhammer esophagus, or type III (spastic) achalasia. Design Retrospective study. Setting International, multicenter, academic institutions. Patients All patients who underwent POEM for treatment of SEDs refractory to medical therapy at 11 centers were included. Interventions POEM. Main Outcome Measurements Eckardt score and adverse events. Results A total of 73 patients underwent POEM for treatment of SEDs (diffuse esophageal spasm 9, jackhammer esophagus 10, spastic achalasia 54). POEM was successfully completed in all patients, with a mean procedural time of 118 minutes. The mean length of the submucosal tunnel was 19 cm, and the mean myotomy length was 16 cm. A total of 8 adverse events (11%) occurred, with 5 rated as mild, 3 moderate, and 0 severe. The mean length of hospital stay was 3.4 days. There was a significant decrease in Eckardt scores after POEM (6.71 vs 1.13; P =.0001). Overall, clinical response was observed in 93% of patients during a mean follow-up of 234 days. Chest pain significantly improved in 87% of patients who reported chest pain before POEM. Repeat manometry after POEM was available in 44 patients and showed resolution of initial manometric abnormalities in all cases. Limitations Retrospective design and selection bias. Conclusion POEM offers a logical therapeutic modality for patients with SEDs refractory to medical therapy. Results from this international study suggest POEM as an effective and safe platform for these patients.",

author = "Khashab, {Mouen A.} and Messallam, {Ahmed A.} and Manabu Onimaru and Teitelbaum, {Ezra N.} and Ujiki, {Michael B.} and Gitelis, {Matthew E.} and Modayil, {Rani J.} and Hungness, {Eric S.} and Stavropoulos, {Stavros N.} and {El Zein}, {Mohamad H.} and Hironari Shiwaku and Rastislav Kunda and Alessandro Repici and Hitomi Minami and Chiu, {Philip W.} and Jeffrey Ponsky and Vivek Kumbhari and Payal Saxena and Maydeo, {Amit P.} and Haruhiro Inoue",

note = "Publisher Copyright: {\textcopyright} 2015 American Society for Gastrointestinal Endoscopy.",

year = "2015",

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doi = "10.1016/j.gie.2014.10.011",

language = "English (US)",

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T1 - International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video)

AU - Khashab, Mouen A.

AU - Messallam, Ahmed A.

AU - Onimaru, Manabu

AU - Teitelbaum, Ezra N.

AU - Ujiki, Michael B.

AU - Gitelis, Matthew E.

AU - Modayil, Rani J.

AU - Hungness, Eric S.

AU - Stavropoulos, Stavros N.

AU - El Zein, Mohamad H.

AU - Shiwaku, Hironari

AU - Kunda, Rastislav

AU - Repici, Alessandro

AU - Minami, Hitomi

AU - Chiu, Philip W.

AU - Ponsky, Jeffrey

AU - Kumbhari, Vivek

AU - Saxena, Payal

AU - Maydeo, Amit P.

AU - Inoue, Haruhiro

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Background Limited data exist on the use of peroral endoscopic myotomy (POEM) for therapy of spastic esophageal disorders (SEDs). Objective To study the efficacy and safety of POEM for the treatment of patients with diffuse esophageal spasm, jackhammer esophagus, or type III (spastic) achalasia. Design Retrospective study. Setting International, multicenter, academic institutions. Patients All patients who underwent POEM for treatment of SEDs refractory to medical therapy at 11 centers were included. Interventions POEM. Main Outcome Measurements Eckardt score and adverse events. Results A total of 73 patients underwent POEM for treatment of SEDs (diffuse esophageal spasm 9, jackhammer esophagus 10, spastic achalasia 54). POEM was successfully completed in all patients, with a mean procedural time of 118 minutes. The mean length of the submucosal tunnel was 19 cm, and the mean myotomy length was 16 cm. A total of 8 adverse events (11%) occurred, with 5 rated as mild, 3 moderate, and 0 severe. The mean length of hospital stay was 3.4 days. There was a significant decrease in Eckardt scores after POEM (6.71 vs 1.13; P =.0001). Overall, clinical response was observed in 93% of patients during a mean follow-up of 234 days. Chest pain significantly improved in 87% of patients who reported chest pain before POEM. Repeat manometry after POEM was available in 44 patients and showed resolution of initial manometric abnormalities in all cases. Limitations Retrospective design and selection bias. Conclusion POEM offers a logical therapeutic modality for patients with SEDs refractory to medical therapy. Results from this international study suggest POEM as an effective and safe platform for these patients.

AB - Background Limited data exist on the use of peroral endoscopic myotomy (POEM) for therapy of spastic esophageal disorders (SEDs). Objective To study the efficacy and safety of POEM for the treatment of patients with diffuse esophageal spasm, jackhammer esophagus, or type III (spastic) achalasia. Design Retrospective study. Setting International, multicenter, academic institutions. Patients All patients who underwent POEM for treatment of SEDs refractory to medical therapy at 11 centers were included. Interventions POEM. Main Outcome Measurements Eckardt score and adverse events. Results A total of 73 patients underwent POEM for treatment of SEDs (diffuse esophageal spasm 9, jackhammer esophagus 10, spastic achalasia 54). POEM was successfully completed in all patients, with a mean procedural time of 118 minutes. The mean length of the submucosal tunnel was 19 cm, and the mean myotomy length was 16 cm. A total of 8 adverse events (11%) occurred, with 5 rated as mild, 3 moderate, and 0 severe. The mean length of hospital stay was 3.4 days. There was a significant decrease in Eckardt scores after POEM (6.71 vs 1.13; P =.0001). Overall, clinical response was observed in 93% of patients during a mean follow-up of 234 days. Chest pain significantly improved in 87% of patients who reported chest pain before POEM. Repeat manometry after POEM was available in 44 patients and showed resolution of initial manometric abnormalities in all cases. Limitations Retrospective design and selection bias. Conclusion POEM offers a logical therapeutic modality for patients with SEDs refractory to medical therapy. Results from this international study suggest POEM as an effective and safe platform for these patients.

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International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video)

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