Abstract
Background
Per oral endoscopic myotomy (POEM) represents a Natural Orifice Transluminal Endoscopic Surgery (NOTES) approach to Heller myotomy. Even though we are now entering an exponential phase of growth with a large number of centers interested in POEM, published data to guide them are limited. As part of the July 2012 NOSCAR meeting, a conference was organized to review POEM and develop a consensus document. Authors SNS and TS who chaired the NOSCAR panel recognized the dearth of published data, which also may lag the rapid developments in POEM. Therefore, they undertook a survey of early POEM adopters around the world to rapidly obtain global, extensive, and current data on POEM. The raw survey data were made available to NOSCAR panel participants to assist with their presentations. We summarize the salient findings of the survey.
Methods
A comprehensive POEM survey was created and tested. The final survey instrument consisted of 197 questions that covered all aspects of POEM, including operator discipline, prior training, patient selection, setting, technique preference, results, adverse events, regulatory requirements, and perspectives on the future. An automated online response collector was used.
Results
The International Per Oral Endoscopic Myotomy Survey (IPOEMS) involved 16 expert centers, 7 in North America, 5 in Asia, 4 in Europe, including all high-volume centers (≥30 POEMs per center), as of July 2012. These centers had performed 841 POEMs. There were modest variations among centers in technique and periprocedural management, but all centers uniformly reported excellent efficacy and safety outcomes.
Conclusions
The international POEM survey provides a “global snapshot” of the experience of early adopters. The excellent outcomes over a large cumulative volume of procedures are in line with those of published small series and lend further support to the notion that POEM represents a paradigm shift in the treatment of achalasia.
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References
Inoue H, Minami H, Satodate H, Shin-Ei K (2009) First clinical experience of submucosal endoscopic myotomy for esophageal achalasia with no skin incision. Gastrointest Endosc 69(5):AB122
Stavropoulos SN, Harris MD, Hida S, Brathwaite C, Demetriou C, Grendell J (2010) Endoscopic submucosal myotomy for the treatment of achalasia. Gastrointest Endosc 72(6):1309–1311
Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42(4):265–271
Zhou PH, Cai MY, Yao LQ, Zhong YS, Ren Z, Xu MD, Chen WF, Qin XY (2011) Peroral endoscopic myotomy for esophageal achalasia: report of 42 cases. Zhonghua Wei Chang Wai Ke Za Zhi 14(9):705–708
von Renteln D, Inoue H, Minami H, Werner YB, Pace A, Kersten JF, Much CC, Schachschal G, Mann O, Keller J, Fuchs KH, Rösch T (2012) Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol 107(3):411–417
Costamagna G, Marchese M, Familiari P, Tringali A, Inoue H, Perri V (2012) Peroral endoscopic myotomy (POEM) for oesophageal achalasia: preliminary results in humans. Dig Liver Dis 44(10):827–832
Stavropoulos SN, Brathwaite CE, Iqbal S, Ghevariya V, Dejesus D, Korrapati V, Widmer J, Friedel D, Grendell J (2012) P.O.E.M. (Per-oral Endoscopic Myotomy), A US Gastroenterologist perspective: initial 2 year experience. Gastrointest Endosc 75(4):AB149
Shiwaku H, Haruhiro Inoue H, Beppu R, Nakashima R, Minami H, Shiroshita T, Yamauchi Y, Hoshino S, Yamashita Y (2013) Successful treatment of diffuse esophageal spam by Peroral endoscopic myotomy. Gastrointest Endosc 77(1):149–150
Swanstrom LL, Kurian A, Dunst CM, Sharata A, Bhayani N, Rieder E (2012) Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg 256(4):659–667
Inoue H, Tianle KM, Ikeda H, Hosoya T, Onimaru M, Yoshida A, Minami H, Kudo SE (2011) Peroral endoscopic myotomy for esophageal achalasia: technique, indication, and outcomes. Thor Surg Clin 21(4):519–525
Ren Z, Zhong Y, Zhou P, Xu M, Cai M, Li L, Shi Q, Yao L (2012) Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases). Surg Endosc 26(11):3267–3272
von Renteln D, Fuchs KH, Fockens P, Bauerfeind P, Vassiliou M, Breithaupt W, Heinrich H, Bredenoord A, Verlaan T, Trevisonno M, RöSch T (2012) Per oral endoscopic myotomy for the treatment of achalasia: prospective international multicenter study. Gastrointest Endosc 75(4S):AB160
Yoshida A, Inoue H, Ikeda H, Hosoya T, Onimaru M, Sudo K, Eleftheriadis N, Maselli R, Kudo SE (2012) Clinical results of POEM (per-oral endoscopic myotomy) for esophageal achalasia in 161 consecutive cases. Gastrointest Endosc 75(4S):AB212
Zhou P, Yao L, Cai M, Zhong Y, Ren Z, Xu M, Chen W, Qin X (2012) Water-jet assisted PerOral Endoscopic Myotomy (POEM) in comparison to conventional endoscopic myotomy technique for treatment of esophageal achalasia. Gastrointest Endosc 75(4S):AB160–AB161
Zhou P, Yao L, Zhang YQ, Cai M, Zhong Y, Ren Z, Xu M, Chen W, Li QL, Qin X (2012) PerOral endoscopic myotomy (POEM) for esophageal achalasia: 205 cases report. Gastrointest Endosc 75(4):132–133
Eleftheriadis N, Inoue H, Ikeda H, Onimaru M, Yoshida A, Hosoya T, Maselli R, Kudo SE (2012) Training in peroral endoscopic myotomy (POEM) for esophageal achalasia. Ther Clin Risk Manage 8:329–342
Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttitta A, Elizalde JI, Fumagalli U, Gaudric M, Rohof WO, Smout AJ, Tack J, Zwinderman AH, Zaninotto G, Busch OR, European Achalasia Trial Investigators (2011) Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med 364(19):1807–1816
Stavropoulos SN, Brathwaite C, Halwan B, Korrapati V, DeJesus D, Iqbal S, Widmer J, Friedel D, Grendell JH (2012) POEM (PerOral Endoscopic Myotomy): effective NOTES (Natural Orifice Transluminal Endoscopic Surgery) accessible to the gastroenterologist, 3-year experience at a U.S. center. Am J Gastroenterol 107:S777–S778
Stein HJ, Liebermann-Meffert D, DeMeester TR, Stewart JR (1995) Three-dimensional pressure image and muscular structure of the human lower esophageal sphincter. Surgery 117(6):692–698
Rohof WO, Hirsch DP, Kessing BF, Boeckxstaens GE (2012) Efficacy of treatment for patients with achalasia depends on the distensibility of the esophagogastric junction. Gastroenterology 143(2):328–335
Bonin EA, Moran E, Bingener J, Knipschield M, Gostout CJ (2012) A comparative study of endoscopic full-thickness and partial-thickness myotomy using submucosal endoscopy with mucosal safety flap (SEMF) technique. Surg Endosc 26(6):1751–1758
Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ (2008) Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 135(5):1526–1533
Stefanidis D, RichardsonW FarrellT, Kohn G, Augenstein V, Fanelli R (2012) SAGES guidelines for the surgical treatment of esophageal achalasia. Surg Endosc 26(2):296–311
Duranceau A, Liberman M, Martin J, Ferraro P (2012) End-stage achalasia. Dis Esophagus 25(4):319–330
Maselli R, Inoue H, Misawa M, Ikeda H, Hosoya T, Onimaru M, Yoshida A, Eleftheriadis N, Suzuki K, Kudo S (2012) Peoral endoscopic myotomy (POEM) in a 3 year old girl with severe growth retardation, achalasia and Down syndrome. Endoscopy 44:E285–E287
Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstätter M, Lin F, Ciovica R (2009) Endoscopic and surgical treatment for achalasia: a systemic review and meta-analysis. Ann Surg 249:45–57
Gholoum S, Feldman LS, Andrew CJ, Bergman S, Demyttenaere S, Mayrand S, Stanbridge DD, Fried GM (2006) Relationship between subjective and objective outcome measures after Heller myotomy and Dor fundoplication for achalasia. Surg Endosc 20(2):214–219
Acknowledgments
We would like to acknowledge the following IPOEMS participants who invested significant time and effort to provide accurate responses reflecting their current POEM experience to the exhaustive and possibly exhausting IPOEMS: Stavros Stavropoulos, Collin Brathwaite, Winthrop University Hospital, Mineola, New York, USA; Thomas Savides, Santiago Horgan, University of California San Diego Medical Center, La Jolla, California, USA; Pinghong Zhou, Jianwei Hu, Zhongshan Hospital, Fudan University, Shanghai, China; Haruhiro Inoue, Showa University Northern Yokohama Hospital, Yokohama, Japan; Lee Swanstrom, The Oregon Clinic, Portland, Oregon, USA; Philip Chiu, The Chinese University of Hong Kong, Hong Kong, China; Guido Costamagna, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy; Hitomi Minami, Nagasaki University Hospital, Nagasaki, Japan; Eric Hungness, Ezra Teitelbaum, Northwestern University, Chicago, Illinois, USA; Horst Neuhaus, Evangelisches Krankenhaus Düsseldorf, Duesseldorf, NRW, Germany; Jeff Marks, University Hospitals, Case Medical Center, Cleveland, Ohio, USA; Jacques Deviere, Erasme University Hospital, Brussels, Belgium; Stefan Seewald, Center for Gastroenterology, Hirslanden Clinic, Zurich, Switzerland; Hironari Shiwaku, Fukuoka University School of Medicine, Fukuoka, Japan; Melina Vassiliou, McGill University Health Centre, Montreal, Quebec, Canada; Christopher Gostout, Mayo Clinic, Rochester, Minnesota, USA.
Disclosures
Dr. Stavros N. Stavropoulos has received an honorarium from ERBE Elektromedizin GmbH. Drs. Rani Modayil, David Friedel, and Thomas J. Savides have no conflict of interest or financial ties to disclose.
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Stavropoulos, S.N., Modayil, R.J., Friedel, D. et al. The International Per Oral Endoscopic Myotomy Survey (IPOEMS): a snapshot of the global POEM experience. Surg Endosc 27, 3322–3338 (2013). https://doi.org/10.1007/s00464-013-2913-8
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DOI: https://doi.org/10.1007/s00464-013-2913-8