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

Konda_POEM.AftertheCutNowWhat

Pdf Summary

This document discusses several cases related to esophageal disorders and post-procedure management. <br /><br />Case L involves a 50-year-old patient with EGJOO (esophagogastric junction outflow obstruction) and hypercontractile features. They underwent a procedure called POEM (peroral endoscopic myotomy) and recovered well. However, they are still struggling to advance past liquids after 6-8 weeks. The suggested additional treatment for this patient is antifungal therapy, reassurance, reflux testing, prokinetic therapy, and diet and lifestyle counseling.<br /><br />Case M involves a 70-year-old patient with Jackhammer esophagus who underwent a long myotomy in 2018. Over the past year, they have experienced a step-down to soft, bland food and continued heartburn symptoms despite taking omeprazole. The recommended approach for this patient includes reflux optimization through acid control, avoiding trigger foods, controlling overall volume, and preparing for the night by going down instead of up.<br /><br />Case N features a 37-year-old female with achalasia Type II who initially could only tolerate a liquid diet, resulting in a 30-pound weight loss. After undergoing a myotomy, she was able to eat again. However, there are concerns about maladaptive behaviors around eating, weight gain, body image issues, and depression. The suggested management includes counseling, weight management, and addressing esophageal function.<br /><br />Case O involves a 28-year-old patient with Type 2 achalasia who underwent a Heller myotomy. Despite improvement, they still experience dysphagia to solid foods and chest pain. An esophagram indicated narrowing at the gastroesophageal junction (GEJ) with severe esophageal dysmotility. The proposed intervention for this patient is a botulinum toxin injection trial to address residual spasm above the myotomy effect. If successful, a completion myotomy via POEM may be considered.<br /><br />The document also discusses expectations in terms of care plans, disease management, surveillance, and future goals for patients with esophageal disorders. These include relieving dysphagia symptoms, tolerating a varied diet, managing reflux, and monitoring for recurrence or progression of the disease.

Keywords

esophageal disorders

post-procedure management

POEM

reflux testing

prokinetic therapy

Jackhammer esophagus

Heller myotomy

dysphagia

botulinum toxin injection

care plans