Double-scope POEM Ensures Complete Myotomy in Patients With Achalasia

Issue: June 2015

A second endoscope was useful for ensuring a complete gastric myotomy during peroral endoscopic myotomy, or POEM, for treatment of achalasia, according to data presented at the Society of American Gastrointestinal and Endoscopic Surgeons 2015 Annual Meeting.

“POEM is a safe and effective treatment for esophageal achalasia, and our clinical success rate in this series was 93% to 97%,” Kevin L. Grimes, MD, from Showa University Koto-Toyosu Hospital in Japan, told Healio Gastroenterology. “The biggest risk factor for clinical failure of the POEM procedure is not dividing enough muscle on the gastric side of the gastroesophageal junction. In this study, we used a second endoscope to check the extent of our gastric myotomy during POEM, and in over one-third of cases we felt that the myotomy should be extended.”

Kevin L. Grimes

Grimes and colleagues randomly assigned 50 patients each to single-scope or double-scope POEM. Mean procedure time was 77 ± 26 minutes in the single-scope group compared with 94 ± 34 minutes in the double-scope group (P = .007). Patient demographics, intra- and postoperative complications, and length of stay were comparable between groups. Use of the second scope resulted in additional myotomy being performed in 34% of the double-scope group (vs. 0% single-scope; P < .00001), with an average increase of 1.6 ± 1 cm.

“The double-scope technique is a simple way of ensuring that the gastric myotomy length is adequate, and it does not require any specialized training or equipment,” Grimes said. Most complications “were very minor, and all of the patients in the study have recovered and are doing well,” he added. – by Adam Leitenberger

Reference:

Grimes KL, Inoue H. Abstract S011. Presented at: Society of American Gastrointestinal and Endoscopic Surgeons Annual Meeting; April 15-18, 2015, Nashville, Tenn.

Disclosure: Grimes reports no relevant financial disclosures.