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

Video Transcription

Video Summary

In this video, Peter Dragunov from the University of Florida discusses various tools and techniques used in the procedure called Peroral Endoscopic Myotomy (POEM). The first topic he addresses is the tools needed for the procedure. He recommends using an endoscope with a water jet function to handle bleeding efficiently. A good retroflexion on the endoscope is also important. He suggests using a distal attachment, either cylindrical or conical, depending on personal preference. Carbon dioxide should be used for insufflation instead of room air. He emphasizes the importance of checking that the air button on the Olympus processor is turned off to avoid using room air. For the injection solution, a saline stain with a little bit of methylene blue is preferred. He mentions that while epinephrine can be beneficial in some cases, it is more controversial for POEM. He advises using a microprocessor controlled generator for electrosurgical equipment. He discusses different types of knives for POEM, particularly favoring the hybrid knife and the triangular tip knife. Coagulating forceps are also essential to have. <br />Moving on to techniques, Dragunov discusses variations of the POEM procedure. He explains that mucosal incisions can be either longitudinal or transverse, with longitudinal being more commonly used. Closing the incision with clips is usually sufficient, but suturing or over-the-scope clips can also be options. He discusses the direction of the myotomy, with most experts using a proximal to distal approach. The orientation of the myotomy can be anterior or posterior, with anterior being the more common choice. He notes that there is still ongoing research about the optimal length of the myotomy in the esophagus and the cardiac region. Different measurement techniques are utilized, including anatomical landmarks, injection with dye, and double scope transillumination. Dragunov summarizes that a dedicated toolbox with specific tools is necessary for POEM, and that current research suggests several variations in techniques.

Asset Subtitle

Peter Draganov, MD

Keywords

Peroral Endoscopic Myotomy

POEM procedure

tools for POEM

techniques for POEM

myotomy variations