ASGE Peroral Endoscopic Myotomy (POEM) Pearls to Practice: (On-Demand)

Gyawali_POEM complications

Pdf Summary

This document discusses various aspects of the identification and management of complications in patients with esophageal disorders such as achalasia and gastroesophageal reflux disease (GERD). It summarizes key findings from research studies and provides recommendations for clinical practice.<br /><br />One study compared the outcomes of peroral endoscopic myotomy (POEM) and pneumatic dilation (PD) in patients with achalasia. It found that POEM had a higher treatment success rate at 5-year follow-up compared to PD, but patients who underwent POEM had a higher risk of developing reflux symptoms. Another study compared POEM with laparoscopic Heller myotomy (LHM) and found no significant difference in treatment success between the two procedures at 2-year follow-up.<br /><br />The document also discusses the approach to managing reflux symptoms. It suggests conducting tests such as endoscopy, pH monitoring, and impedance monitoring to determine the presence of GERD. It recommends optimizing proton pump inhibitor (PPI) therapy and considering alternative pharmacotherapy options, such as potassium competitive acid blockers, in patients who do not respond to PPIs.<br /><br />The document highlights the use of various assessment tools, such as timed upright barium study, functional luminal imaging probe (FLIP), and high-resolution manometry (HRM), to evaluate treatment response in patients with esophageal disorders. It also discusses the management of complications, including blown-out myotomy and spastic motor disorders.<br /><br />Furthermore, the document discusses the use of adjunctive therapies, such as smooth-muscle relaxants, Botox, and balloon dilation, in managing spastic motor disorders. It suggests considering empirical PPI trials or antidepressant trials for patients with chest pain or discomfort.<br /><br />Overall, this document provides a comprehensive overview of the complications associated with esophageal disorders and offers guidance on their identification and management.

Keywords

complications

esophageal disorders

achalasia

reflux symptoms

laparoscopic Heller myotomy

GERD

proton pump inhibitor therapy

assessment tools

spastic motor disorders

adjunctive therapies