Peroral endoscopic myotomy and fundoplication: a novel NOTES procedure

Haruhiro Inoue; Akiko Ueno; Yuto Shimamura; Anastassios Manolakis; Ashish Sharma; Shin Kono; Masayuki Nishimoto; Kazuya Sumi; Haruo Ikeda; Kenichi Goda; Manabu Onimaru; Noriko Yamaguchi; Hiroaki Itoh

doi:10.1055/a-0820-2731

Endoscopy, Inhaltsverzeichnis

Endoscopy 2019; 51(02): 161-164
DOI: 10.1055/a-0820-2731

Innovations and brief communications

Peroral endoscopic myotomy and fundoplication: a novel NOTES procedure

Authors

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

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.

Volltext

Referenzen

References
1 Inoue H, Minami H, Kobayashi Y. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271
2 Swanstrom LL, Kurian A, Dunst CM. et al. Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg 2012; 256: 659-667
3 Kumbhari V, Familiari P, Bjerregaard NC. et al. Gastroesophagal reflux after peroral endoscopic myotomy: a multicenter case-control study. Endoscopy 2017; 49: 634-642
4 Wang XH, Tan YY, Zhu HY. et al. Full-thickness myotomy is associated with higher rate of postoperative gastroesophageal reflux disease. World J Gastroenterol 2016; 22: 9419-9426
5 Kahrilas PJ, Bredenoord AJ, Fox M. et al. International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 2015; 27: 160-174
6 Grimes KL, Inoue H, Onimaru M. et al. Double-scope per oral endoscopic myotomy (POEM): a prospective randomized controlled trial. Surg Endosc 2016; 30: 1344-1351