Jet injection of dyed saline facilitates efficient peroral endoscopic myotomy

Mouen A. Khashab; Ahmed A. Messallam; Payal Saxena; Vivek Kumbhari; Ernesto Ricourt; Gerard Aguila; Bani Chander Roland; Ellen Stein; Monica Nandwani; Haruhiro Inoue; John O. Clarke

doi:10.1055/s-0033-1359024

Endoscopy, Table of Contents

Endoscopy 2014; 46(04): 298-301
DOI: 10.1055/s-0033-1359024

Innovations and brief communications

Jet injection of dyed saline facilitates efficient peroral endoscopic myotomy

Mouen A. Khashab

¹Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

,

Ahmed A. Messallam

¹Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

,

Payal Saxena

¹Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

,

Vivek Kumbhari

¹Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

,

Ernesto Ricourt

¹Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

,

Gerard Aguila

¹Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

,

Bani Chander Roland

¹Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

,

Ellen Stein

¹Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

,

Monica Nandwani

¹Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

,

Haruhiro Inoue

²Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

,

John O. Clarke

¹Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

› Author Affiliations

Abstract

Background and study aims: Peroral endoscopic myotomy (POEM) is technically challenging and time consuming. Repeated injection of dyed saline during tunneling is performed to enhance the demarcation between the submucosal layer and the muscularis propria. This process requires exchanging the knife for a catheter to spray dyed saline and is time consuming. This study aimed to describe a new method of injecting dyed saline through an integrated water jet channel during POEM.

Patients and methods: POEM was performed using a triangular tip knife. Repeated jet injection of saline mixed with indigo carmine was performed whenever the submucosal dissection plane became unclear.

Results: The study cohort consisted of nine patients (8 achalasia, 1 Jackhammer esophagus). All procedures were technically feasible and successful without any complications and resulted in the patients’ Eckhardt’s scores returning to normal. The mean submucosal tunnel length was 13.3 cm and the mean myotomy length was 9.9 cm. The mean procedure time was 127 minutes.

Conclusion: The modified POEM technique with use of jet injection of dyed saline is simple and may render POEM easier and more efficient than the standard dissection method.

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References

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