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

Video Transcription

Video Summary

In this video, Peter Dragunov from the University of Florida discusses various tools and techniques used for POEM (Peroral Endoscopic Myotomy). He suggests using an endoscope with a water jet function to independently irrigate in case of bleeding. He also recommends choosing an endoscope with good retroflexion. A distal attachment on the scope and a coagulating forceps are essential tools. Carbon dioxide should be used for insufflation instead of room air. For injection solution, saline mixed with a small amount of methylene blue is commonly used. Epinephrine is not necessary for POEM, but can be beneficial in some cases. A microprocessor-controlled generator is recommended for electrosurgical equipment. There are two main types of knives used for POEM, the hybrid knife and the triangular tip knife. It is important to have a dedicated toolbox for all the necessary devices used in POEM. Various techniques for mucosal incision and myotomy are discussed, including the use of clips and suturing for incision closure. Anterior and posterior myotomies are considered equivalent. The optimal length of the myotomy in the esophagus and the cardia are still areas of active research, with short esophageal myotomies of around 3 cm appearing to be effective. Accurate measurement of the myotomy in the cardia can be challenging, but various methods such as anatomical landmarks and transillumination with two scopes can be used. Confirmatory data is needed for some of these techniques and measurements.

Asset Subtitle

Peter Draganov, MD

Keywords

POEM

endoscope

myotomy

electrosurgical equipment

measurement