POEM Contraindications and Pitfalls
Fig. 7.1 (a, b) Demonstration of luminal narrowing secondary to peptic strictures after Heller myotomy. (c, d) Demonstration of luminal narrowing secondary to achalasic sphincter Fig. 7.2 Patient status after…
Current and Emerging Instruments and Energy
Fig. 3.1 GI endoscope used for POEM Overtubes Overtubes have the ability to facilitate luminal access during POEM and potentially limit oropharyngeal trauma with repeated esophageal intubation throughout a procedure….
Technical Modifications for Motility Disorders: Dimensions of Dissection
Fig. 6.1 Barium esophagram demonstrating each type of achalasia. Type 1 achalasia (a) with dilated esophagus and bird’s beak appearance at the lower esophageal sphincter (LES). Type II achalasia (b)…
Clinical Introduction of POEM for Achalasia: Technique
Fig. 5.1 Gastroscope with overtube (arrow) placed The required supplies for each step are listed in Table 5.1 with ancillary equipment described in Table 5.2. A clear endoscopic cap that…
Submucosal Surgery: Pyloromyotomy and Tumor Enucleation
Fig. 15.1 Initial longitudinal mucosal incision is performed following submucosal injection of a lifting solution.The submucosal space stained with the dilute methylene blue solution can be seen Fig. 15.2 The…
Follow-Up and Surveillance
Fig. 12.1 Eckardt score However, patients’ symptoms following POEM may not necessarily be a reliable indicator of functional improvement after treatment as symptom resolution can occur without a significant improvement…
Future Applications of Submucosal Surgery: NOTES, Full-Thickness Resections and Beyond
Fig. 16.1 Endoscopic interventions with submucosal navigation. (1) NOTES natural orifice transluminal surgery (SEMF valve approach). (2) Endoscopic myotomies—POEM peroral endoscopic myotomy, POP peroral pyloroplasty. (3) Endoscopic tumor resection—STER submucosal…
Indications and Preoperative Workup for Peroral Endoscopic Myotomy
Score Dysphagia Regurgitation Retrosternal pain Weight loss (kg) 0 None None None None 1 Occasional Occasional Occasional <5 2 Daily Daily Daily 5–10 3 Each meal Each meal Each meal…
Training, Credentialing, and Developing a Clinical Program for POEM
Fig. 14.1 GERD-HRQL. Scale: 0 = no symptoms. 1 = dymptoms noticeable, but not bothersome. 2 = symptoms noticeable and bothersome, but not every day. 3 = symptoms bothersome every day. 4 = symptoms affect daily activities. 5 = symptoms are incapacitating,…
Endoscopic Myotomy for Non-achalasia Esophageal Disorders
IRP % Normal peristalsis % Premature contractions (spasm) with normal DCI DCI (mmHg)(s)(cm) Type I/II achalasia High 0% 0% <100 Type III (spastic achalasia) High 0% 20% >450 DES…
