ASGE Peroral Endoscopic Myotomy (POEM) Pearls to Practice: (On-Demand) | July 2022-Shimamura_POEM Procedures tips and tricks case discussion

Shimamura_POEM Procedures tips and tricks case discussion

Pdf Summary

This document provides a summary of procedures, tips, and tricks for performing peroral endoscopic myotomy (POEM). The document begins with the importance of preoperative patient assessment, fasting, and esophageal cleansing. The use of antifungal drugs is recommended if esophageal candidiasis is confirmed. Sufficient lavage of the esophagus is essential to prevent contamination during the procedure. <br /><br />The preparation for POEM includes the use of certain equipment such as the TT Knife J, Space adjuster, and various endoscopic instruments. CO2 insufflation is mandatory in the operating room, and low-flow gas tubes are recommended. <br /><br />The anesthesia method utilized is general anesthesia with controlled ventilation, and rapid induction with cricoid pressure is recommended. The POEM procedure involves mucosal incision, submucosal tunneling, myotomy, and mucosal closure. It is important to perform the procedures correctly to avoid complications such as diverticulum or esophagotracheal fistula. <br /><br />The document also discusses the double scope method, which involves using a second gastroscope to assist in controlling myotomy length and direction. Tips and tricks for POEM include the use of the triangle tip of the knife, creating a straight tunnel, and paying attention to vascular structures. <br /><br />Finally, two video case discussions highlight different scenarios and provide options for managing difficulties during POEM procedures. Overall, the document emphasizes the importance of thorough preparation, proper technique, and being prepared for common challenges that may arise during POEM.

Keywords

peroral endoscopic myotomy

POEM

preoperative patient assessment

esophageal candidiasis

lavage

CO2 insufflation

anesthesia

mucosal incision

double scope method

video case discussions