ASGE Peroral Endoscopic Myotomy (POEM) Pearls to Practice: LIVE and Virtual | July 2022-Pandolfino

Pandolfino_ASGE POEM Case 7-16-22

Pdf Summary

This document discusses various aspects of achalasia treatment and post-intervention issues. Achalasia is better defined now due to high-resolution manometry, which allows for a more accurate assessment of impaired relaxation and an understanding of esophagogastric junction (EGJ) opening and anatomy. Treatment strategies for achalasia include tailored therapy and monitoring response intraoperatively with FLIP.<br /><br />The document also highlights the importance of understanding the subtypes of achalasia, such as absent peristalsis, pan-esophageal pressurization, spasm, and variant with intact peristalsis. It provides a flowchart for the classification of achalasia based on various criteria.<br /><br />Post-peroral endoscopic myotomy (POEM) disasters and what to do next are discussed, including the assessment and management of complications. The document emphasizes the importance of considering the severity of the motility disturbance, assessing for context in terms of presentation and anatomy, and performing further diagnostics as necessary.<br /><br />The relevance of achalasia classification is also explored, highlighting the importance of understanding the different subtypes for tailored treatment approaches. The document discusses different studies and research findings related to achalasia treatment, including the use of functional luminal imaging probe panometry (FLIP) to distinguish true esophagogastric junction outflow obstruction.<br /><br />Other topics covered in the document include the modification of POEM to reduce the risk of blown-out myotomy (BOM), the assessment of esophagogastric junction opening dynamics in the context of peristalsis, and the predictors of symptoms in achalasia patients after treatment.<br /><br />The document concludes with a discussion on the post-intervention issues of GERD and dor issues or hernia in achalasia patients. It highlights the importance of careful patient selection and considering modifying the myotomy approach to decrease GERD and BOM.<br /><br />Overall, the document provides a comprehensive overview of achalasia treatment and post-intervention considerations.

Keywords

achalasia treatment

high-resolution manometry

esophagogastric junction

tailored therapy

FLIP

achalasia subtypes

peroral endoscopic myotomy

motility disturbance

GERD

post-intervention considerations