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Poem 03 15
- 1. POEM D Nageshwar ReddyMD, DM, DSc, FAMS, FRCP, FASGE, FACG, MWGO Asian Institute of Gastroenterology Hyderabad, India.
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- 4. Achalasia Cardia Balloon DilatationPOEM Heller lap Myotomy Treatment Type III Achalasia Failed Heller’s Myotomy Failed Pneumatic dilatation
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- 6. POEM Technique of mucosalincision: Mohan Ramchandani, D N Reddy. Clinical Gastroenterol and hepatol 2013
- 7. Technique of mucosalincision Mohan Ramchandani, D N Reddy. Clinical Gastroenterol and hepatol 2013
- 8. POEM Technique STEP-2 Submucosaldissection
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- 10. POEM Technique STEP-4 Closureof mucosal incision
- 11. Timed Barium (1Minute) Pre Dilatation Post Dilatation
- 12. POEM : AIGdata 282 patients M F FPD Type III FHM SO T I&II 6 months 24 10 LES pressure Eckhardt Score Pre Post Pre Post Reddy DN. Ramchandani M. Digestive Endoscopy 2015
- 13. Successful POEM inSitus Inversus Totalis Domenico Galasso, Mohan Ramchandani, Rakesh Kalpala, Sundeep Lakhtakia, Rajesh Gupta, Santosh Darisetty, D.Nageshwar Reddy Endoscopy 2014
- 14. Reddy D N282 7/1 23/9 90% 10 - World J Gastrointest Endosc 2015
- 15. The surgical argument Whynot POEM •Invasive ? •Not effective •Side effects •Cost
- 16. Efficacy of peroralendoscopic myotomy (POEM) in the treatment of achalasia cardia: A systematic review and metaanalysis Talukdar R, Inoue H, Reddy DN. Surgical Endoscopy 2014 Eckhart’s score Post-operative pain
- 17. How POEM isdifferent from LHM?
- 18. Can be donein Endoscopy room Equipment required •Standard upper GI scope •Transparent tapered cap •CO2 insufflator •Triangular tip knife •Electrical generator ERBE 300D •Sub mucosal solution – NS+ 0.3% indigo carmine •Injection needles, hemoclips
- 19. Full control onextent of myotomy • Only the circular muscle layer of the esophagus is divided • Length of myotomy can be extended in esophagus
- 20. Preservation of Phreno-Oesophagealmembrane • The hiatus is not mobilized • Vagus nerve is not mobilized • An antireflux procedure is not performed
- 21. GERD after POEM Subjectivedata (GERD symptom score) • No GERD symptoms 68% • Minimal (few times/month) 16% • Moderate (few times/week) 13% • Severe (daily) 3% Stavropoulos et al , Ther Adv Gastroenterol 2013 GERD not as low as initially reported but similar to rate reported in high quality studies post LHM+Dorfundoplication Rawlins, Surg Endo 2012; Khajanchee Arch Surg 2005
- 22. Annals of SurgeryVolume 259, Number 6, June 2014
- 23. Operative Details Heller n =64 POEM n = 37 P Operative time, min Median Range 160 100-280 120 60-215 0.003 Full-thickness injury, n Esophagus Stomach 8 3 4 0 0.1 0.8 Return to the OR, n Bleeding Length of stay,mean day (SD) 1 2.5(1.9) 1 1.1(0.6) <0.0001 OR indicates operating room.
- 24. POEM After FailedHeller’s Myotomy Normal Submucosal dissection Submucosal Fibrosis in prior LHM
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- 26. POEM • Must awaitaccumulation of evidence from well designed clinical trials – Comparative studies – Long term follow up
- 28. Achalasia Cardia indications Balloondilation POEM Heller lap Myotomy Type I,II Type III Type III Elderly Younger Younger < esophageal luminal Failed BD / HM Sigmoid esophagus 70% 20% 10%
- 29. ‘‘There are threesteps in the revelation on any truth: In the first, it is ridiculed; in the second, resisted; in the third, it is considered selfevident.’’ Arthur Schopenhauer
- 30. The ability tothink differently today from yesterday distinguishes the wise man from the stubborn. John Steinbeck