Haruhiro Inoue, MD, PhD. Digestive Disease Center, Showa University Koto Toyosu Hospital
Background: Since its introduction in 2008 POEM (Per-oral endoscopic myotomy) has become a minimally invasive endoscopic treatment of choice for achalasia. In the last 9 years we have performed more than 1500 cases of POEM procedure for achalasia and other esophageal motility disorders. Post POEM signi?cant GER (Gastro-esophageal re?ux) has been noted in multiple studies. In order to overcome this potential adverse event we conducted a pilot study where an endoscopic partial fundoplication was added to the standard POEM procedure (POEM+F) (IRB approval number: 17T5010).
Procedure and patients: 16 consecutive patients after a written informed consent underwent POEM procedure followed by endoscopic fundoplication (POEM+F). After completing the esophageal myotomy the endoscope was advanced into peritoneal cavity through the muscle defect in the abdominal side of submucosal tunnel. Pneumoperitoneum was achieved with CO2 insuf?ation through the endoscope. Using a combination of endo-loop and clips (method I) or a new flexible suturing device (mehod II) the anterior wall of gastric fundus is pulled and ?xed to the esophagogastric junction (EGJ) creating a partial wrap at the gastric cardia. In POEM+F the ef?cacy of the newly created anti-re?ux barrier was evaluated by 24hr pH impedance study. At the same period 4 cases which received conventional POEM without fundoplication was analyzed as a control group.
Clinical results: In all cases POEM+F a visually recognizable wrap with narrowing of the patulous EGJ was noted. The fundoplication added about 33 minutes to the standard POEM procedure. Clinical course after POEM+F was uneventful. No adverse event was observed in POEM+F. Both medhod I and II, visually recognizable wrap was successfully created. Hospital stay and dosage of pain controller were equal to conventional POEM. A study using 24hr pH impedance monitoring at two months after procedure demonstrated better anti-re?ux effect in the case of POEM+F (P=0.04).
Discussion: POEM+F was technically feasible. In order to clarify real anti-re?ux effect of POEM+F, RCT in large series needs to be conducted.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91106
Program Number: ETP831
Presentation Session: Emerging Technology iPoster Session (Non CME)
Presentation Type: Poster