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

Video Transcription

Video Summary

In this video, Dr. Vani Konda discusses the Patient Selection and Chicago Classification 4.0 for the Peroral Endoscopic Myotomy (POEM) procedure. She begins by introducing the objectives of the presentation, which include understanding how the overall assessment provides context for diagnosing esophageal motility disorders, reviewing updates to the Chicago Classification 4.0, and discussing management options and tailored decision-making approaches.<br /><br />Dr. Konda discusses achalasia, the major motor disorder of the esophagus, characterized by impaired esophageal peristalsis and failure of the lower esophageal sphincter to relax. She emphasizes the importance of considering other conditions that can mimic achalasia and the need for endoscopic examination to establish non-obstructive dysphagia.<br /><br />She then explains the various modalities used to obtain the clinical context required for diagnosing esophageal motility disorders, including history, physical examination, endoscopy, high-resolution manometry (HRM), barium studies, and functional luminal imaging probe (FLIP).<br /><br />Dr. Konda provides detailed information on how to evaluate dysphagia symptoms, perform a physical examination, and interpret endoscopy findings related to esophageal motility disorders. She explains the protocol and updates to the Chicago Classification 4.0 for HRM, including position changes, provocative maneuvers, and supportive testing.<br /><br />She discusses the different types of achalasia and their diagnostic criteria, as well as other conditions that can present with EGJ (esophagogastric junction) outflow obstruction. Dr. Konda also explains the role of barium esophagram and FLIP in the evaluation of esophageal motility disorders.<br /><br />She concludes by discussing the spectrum of diagnostic certainty and the importance of using multiple modalities to determine the appropriate management approach for esophageal motility disorders. Dr. Konda highlights the different interventions available, such as medications, Botox injection, pneumatic dilation, laparoscopic heller myotomy, and POEM, and explains the importance of tailoring the intervention based on the severity of symptoms, impact on quality of life, and potential for organ damage.<br /><br />Overall, this video provides a comprehensive overview of the evaluation and management of esophageal motility disorders, with a focus on the POEM procedure and the Chicago Classification 4.0. No credits were mentioned in the video.

Asset Subtitle

Vani Konda, MD

Keywords

Patient Selection

Chicago Classification 4.0

Peroral Endoscopic Myotomy

Esophageal Motility Disorders

Achalasia

High-Resolution Manometry

Functional Luminal Imaging Probe