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Surgical Management of Achalasia: Peroral Endoscopic Myotomy

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The SAGES Manual of Foregut Surgery

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Abstract

A novel procedure, combining the decreased invasiveness of endoscopic access with the reliability of a surgical myotomy, peroral endoscopic myotomy (POEM), represents a potential paradigm shift in the management of idiopathic achalasia and other esophageal motor disorders. Comprehensive preoperative evaluation by a multidisciplinary team of gastroenterologists and surgeons is essential to confirming candidacy for POEM and appropriately counseling patients on expected outcomes and postoperative outcomes, including the lack of long-term outcome data. The key steps of the procedure are detailed, including initial EGD, safe access to the submucosal space, creation of a submucosal tunnel extending at least 3 cm onto the gastric cardia, selective myotomy of the inner circular muscle fibers, and closure of the mucosotomy. Frequently encountered complications include bleeding, inadvertent mucosotomy, full-thickness perforation, and development of capnothorax and/or capnoperitoneum.

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Abbreviations

DES:

Diffuse esophageal spasm

DI:

Distensibility index

EGD:

Esophagogastroduodenoscopy

EGJ:

Esophagogastric junction

EMR:

Endoscopic mucosal resection

EPT:

Esophageal pressure topography

ES:

Eckardt score

ESD:

Endoscopic submucosal dissection

FLIP:

Functional lumen imaging probe

GERD:

Gastroesophageal reflux disease

HRIM:

High-resolution impedance manometry

HRM:

High-resolution manometry

IDQ:

Impaction-dysphagia questionnaire, GERDQ

LES:

Lower esophageal sphincter

NOTES:

Natural orifice transluminal endoscopic surgery

POEM:

Peroral endoscopic myotomy

TBE:

Timed barium esophagram

VSI:

Visceral sensitivity index

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Author information

Authors and Affiliations

  1. Department of Surgery, Northwestern Memorial Hospital, Chicago, IL, USA

    Joel Sternbach & Eric Hungness

Authors
  1. Joel Sternbach
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  2. Eric Hungness
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Corresponding author

Correspondence to Eric Hungness .

Editor information

Editors and Affiliations

  1. University of Alabama at Birmingham , Birmingham, AL, USA

    Jayleen Grams

  2. The Ohio State University, Columbus, OH, USA

    Kyle A. Perry

  3. Brigham and Women’s Hospital, Boston, MA, USA

    Ali Tavakkoli

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Sternbach, J., Hungness, E. (2019). Surgical Management of Achalasia: Peroral Endoscopic Myotomy. In: Grams, J., Perry, K., Tavakkoli, A. (eds) The SAGES Manual of Foregut Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-96122-4_38

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  • DOI: https://doi.org/10.1007/978-3-319-96122-4_38

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-96121-7

  • Online ISBN: 978-3-319-96122-4

  • eBook Packages: MedicineMedicine (R0)

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