ASGE Peroral Endoscopic Myotomy (POEM) Pearls to Practice: LIVE and Virtual

Konda_POEM.AftertheCutNowWhat

Pdf Summary

The document discusses several case presentations regarding patients who have undergone procedures for esophageal conditions such as EGJOO, Jackhammer esophagus, achalasia, and Type 2 achalasia. The cases highlight various challenges that patients may face after undergoing procedures like POEM (peroral endoscopic myotomy) and Heller myotomy. The document also provides recommendations and management strategies for these post-procedure issues.<br /><br />For instance, in Case L, a 50-year-old patient with EGJOO and hypercontractile features is struggling to advance past liquids after undergoing a long myotomy. The recommended approach includes diet and lifestyle modifications such as a soft diet, avoiding tough meats and bulky breads, drinking water, and avoiding eating before bedtime. The importance of managing the esophagus by being the gatekeeper and cleaning it up is emphasized.<br /><br />Case M involves a 70-year-old patient with Jackhammer esophagus who experiences step-down to soft, bland food and heartburn symptoms despite taking omeprazole. Reflux optimization, including acid control, avoiding trigger foods, and managing overall volume, is suggested.<br /><br />In Case N, a 37-year-old female with achalasia type II undergoes a myotomy and experiences weight gain after previously tolerating only a liquid diet. The importance of addressing maladaptive behaviors around eating, body image issues, and depression is emphasized, along with counseling, weight management, and esophageal function evaluations.<br /><br />Case O involves a 28-year-old patient with Type 2 achalasia who undergoes a Heller myotomy but continues to experience dysphagia and chest pain. The case suggests considering a botulinum toxin injection trial for spastic segments above the myotomy effect and LES and tailoring the POEM procedure accordingly.<br /><br />The document also discusses expectations for care plans, disease management, goals, surveillance, and future considerations. It emphasizes that while procedures can relieve dysphagia symptoms and enable a varied diet, they may not guarantee resolution of pain symptoms or restore normal esophageal function. Surveillance for disease recurrence, reflux, and neoplasia is recommended, and reflux may need to be managed with medications or anti-reflux procedures.<br /><br />Overall, the document provides insights into post-procedure challenges and recommendations for managing esophageal conditions and optimizing patient outcomes.

Keywords

esophageal conditions

EGJOO

Jackhammer esophagus

achalasia

POEM

Heller myotomy

post-procedure issues

reflux optimization

weight management

esophageal function evaluations