Endoscopy 2019; 51(02): 161-164
DOI: 10.1055/a-0820-2731
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Peroral endoscopic myotomy and fundoplication: a novel NOTES procedure

Haruhiro Inoue
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Akiko Ueno
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Yuto Shimamura
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Anastassios Manolakis
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Ashish Sharma
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Shin Kono
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Masayuki Nishimoto
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Kazuya Sumi
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Haruo Ikeda
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Kenichi Goda
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Manabu Onimaru
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Noriko Yamaguchi
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Hiroaki Itoh
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

submitted 02 March 2018

accepted after revision 01 November 2018

Publication Date:
17 January 2019 (eFirst)

Abstract

Background Peroral endoscopic myotomy (POEM) has become the minimally invasive endoscopic treatment for achalasia; however, gastroesophageal reflux (GER) post-POEM has been reported. A pilot study was conducted in which an endoscopic fundoplication was added to the standard POEM (POEM + F) procedure to overcome this issue. We report the technical details of POEM + F and short-term safety results.

Methods POEM + F was performed in 21 patients. After completing myotomy, the endoscope was advanced from the submucosal tunnel into the peritoneal cavity. A partial mechanical barrier was created by retracting the anterior gastric wall at the esophagogastric junction with the use of endoclips and an endoloop.

Results POEM + F was technically feasible in all cases and created a visually recognizable fundoplication. The clinical course after POEM + F was uneventful. No immediate or delayed complications occurred.

Conclusion POEM + F may help mitigate the post-POEM incidence of GER and serve as a minimally invasive endoscopic alternative to a laparoscopic Heller-Dor procedure. This is the largest case series of peroral natural orifice transluminal endoscopic surgery without laparoscopic assistance in the human foregut.