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CC BY 4.0 · Journal of Digestive Endoscopy 2024; 15(01): 42-48
DOI: 10.1055/s-0044-1779339
Research Article

Failure of Per-Oral Endoscopic Myotomy (POEM) for Achalasia Cardia—LES-Directed Therapy or Esophageal Body Therapy-Directed Therapy?: A Pictorial High-Resolution Esophageal Manometry (HREM) Case-Based Analysis

Zubin Dev Sharma 
1   Department of Gastroenterology, Institute of Digestive & Hepatobiliary Sciences, Medanta Medicity, Gurugram, Haryana, India
,
Rajesh Puri
1   Department of Gastroenterology, Institute of Digestive & Hepatobiliary Sciences, Medanta Medicity, Gurugram, Haryana, India
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Abstract

Per-oral endoscopic myotomy (POEM) is one of the main modalities of treatment of achalasia cardia today across subtypes and we are increasingly seeing patients persistent or recurrent symptoms after POEM. An accurate high-resolution esophageal manometry (HREM) is one of the most important tests that can help us guide the treatment in cases of failure of POEM. HREM can help us direct the therapy. The therapy can be lower esophageal sphincter-directed therapy or esophageal body-directed therapy that can be ascertained using HREM. With this review, we detail the factors associated with failure of POEM, tests that can be utilized for its evaluation, and case-based analysis using HREM in patients of post-POEM failure.

Keywords

achalasia cardia - HREM - POEM - redo POEM

Author's Contributions

Z.D.S. conceptualized the article and helped in preparation of manuscript and testing for failures. R.P. conceptualized the article and helped in proof reading of manuscript and final approval.




Publication History

Article published online:
21 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Inoue H, Minami H, Kobayashi Y. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42 (04) 265-271
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Nabi Z, Chavan R, Ramchandani M. et al. Long-term outcomes of per-oral endoscopic myotomy in spastic esophageal motility disorders: a large, single-center study. J Clin Gastroenterol 2021; 55 (07) 594-601
    CrossrefPubMedSearch in Google Scholar
  • 3 Werner YB, Hakanson B, Martinek J. et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. N Engl J Med 2019; 381 (23) 2219-2229
    CrossrefPubMedSearch in Google Scholar
  • 4 Modayil RJ, Zhang X, Rothberg B. et al. Peroral endoscopic myotomy: 10-year outcomes from a large, single-center U.S. series with high follow-up completion and comprehensive analysis of long-term efficacy, safety, objective GERD, and endoscopic functional luminal assessment. Gastrointest Endosc 2021; 94 (05) 930-942
    CrossrefPubMedSearch in Google Scholar
  • 5 Ichkhanian Y, Assis D, Familiari P. et al. Management of patients after failed peroral endoscopic myotomy: a multicenter study. Endoscopy 2021; 53 (10) 1003-1010
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Vauquelin B, Quénéhervé L, Pioche M. et al Factors associated with early failure of peroral endoscopic myotomy in achalasia. . Gastrointestinal Endoscopy, 2023
    PubMedSearch in Google Scholar
  • 7 Kostic SV, Rice TW, Baker ME. et al. Timed barium esophagogram: a simple physiologic assessment for achalasia. J Thorac Cardiovasc Surg 2000;120(05):
  • 8 DeWitt JM, Siwiec RM, Perkins A. et al. Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response. Endosc Int Open 2021; 9 (11) E1692-E1701
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Sternbach JM, El Khoury R, Teitelbaum EN. Early esophagram in per-oral endoscopic myotomy (POEM) for achalasia does not predict long-term outcomes. Surgery 2015; 158 (04) 1128-1135
    CrossrefPubMedSearch in Google Scholar
  • 10 Alonso P, González-Conde B, Macenlle R, Pita S, Vázquez-Iglesias JL. Achalasia: the usefulness of manometry for evaluation of treatment. Dig Dis Sci 1999; 44 (03) 536-541
    CrossrefPubMedSearch in Google Scholar