Grace Ann McCurdy, BS, MS1, Tonia Gooden, MD2, Francesca Weis, BS3, Maryam Mubashir, MD4, Shazia Rashid, MD3, Syed Musa Raza, MD2, James Morris, MD, FACG1, Qiang Cai, MD3 1LSU Health Sciences Center, Shreveport, LA; 2Louisiana State University Health Sciences Center, Shreveport, LA; 3LSUHSC, Shreveport, LA; 4O-LSUS, Shreveport, LA
Introduction: Peroral endoscopic myotomy (POEM or E-POEM) was introduced in the last decade to treat primary achalasia, and has since been developed into different techniques including gastric POEM (G-POEM), Zenker’s POEM (Z-POEM), and diverticulum POEM (D-POEM). POEM has a clinical success (defined as post therapy Eckardt scores < 3 and no further treatments) of greater than 90% after 2-3 years and greater than 80% after 5 years. POEM is now applicable to treat non-achalasia esophageal motility disorders including nutcracker esophagus, jackhammer esophagus (JE), diffuse esophageal spasm (DES) and esophagogastric junction outflow obstruction (EGJOO). The purpose of this paper is to document unedited videos of E-POEM, G-POEM, Z-POEM and D-POEM that are less than 10 minutes long.
Case Description/Methods: E-POEM was performed on a 28-year-old female with dysphagia occurring daily for 6 months. G-POEM was performed on a 29-year-old female with idiopathic gastroparesis for one year despite dietary modifications and medications. The patient that underwent Z-POEM is a 58-year-old male with dysphagia and regurgitation for many years, with worsening during the last two years and weight loss. D-POEM was performed on a 67-year-old female patient with dysphagia for a few years that had an EGD showing a large diverticulum in the middle esophagus. All of these POEM procedures were videoed and not edited. They are all under 10 minutes.
Discussion: The patient that underwent E-POEM was discharged with a reduction of symptoms and an Eckardt score decrease from 7 to 2. The patient that underwent G-POEM reported a decrease in symptoms and had a gastroparesis cardinal symptoms index reduction from 3.5 to 1.5. The patient that underwent Z-POEM reported reduction of symptoms and improvement of food tolerance 1 month post procedure. The patient that underwent D-POEM reported improvement of symptoms. No adverse events were reported from any of the patients.
We are providing unedited videos of four different types of POEM procedures to allow more endoscopists to use these techniques in order to benefit patients. Based on experience, when performing a POEM it is advised to always use CO2 and a cap on the tip of the endoscopy, as well as to never perform a POEM on a patient with severe esophagitis or gastritis.
