Stephanie G. Worrell, MD, Evan T

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Presentation transcript:

Peroral Endoscopic Myotomy for Achalasia in a Thoracic Surgical Practice Stephanie G. Worrell, MD, Evan T. Alicuben, MD, Joshua Boys, MD, Steven R. DeMeester, MD The Annals of Thoracic Surgery Volume 101, Issue 1, Pages 218-225 (January 2016) DOI: 10.1016/j.athoracsur.2015.06.036 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 View of the dissecting endoscope in the distal extent of the submucosal tunnel using a retroflexed pediatric endoscope in the stomach. The 3-cm distance of the tunnel beyond the gastroesophageal junction is nicely verified. The Annals of Thoracic Surgery 2016 101, 218-225DOI: (10.1016/j.athoracsur.2015.06.036) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The change in Eckardt score based on the high-resolution manometric type of achalasia. The Annals of Thoracic Surgery 2016 101, 218-225DOI: (10.1016/j.athoracsur.2015.06.036) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Esophageal emptying by timed barium swallow testing increased from a median of 36% at 5 minutes to 95% at 5 minutes after peroral endoscopic myotomy (p < 0.0001). The Annals of Thoracic Surgery 2016 101, 218-225DOI: (10.1016/j.athoracsur.2015.06.036) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Upper endoscopy after peroral endoscopic myotomy (n = 22) showed esophagitis in 55% of patients. The esophagitis was LA grade A (n = 3) or B (n = 8) in most patients. The single patient with LA grade D esophagitis had a concomitant hiatal hernia. The Annals of Thoracic Surgery 2016 101, 218-225DOI: (10.1016/j.athoracsur.2015.06.036) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 The integrated relaxation pressure before (pre) and after (post) peroral endoscopic myotomy (POEM) in 10 patients compared with the normal value [5]. The Annals of Thoracic Surgery 2016 101, 218-225DOI: (10.1016/j.athoracsur.2015.06.036) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 High-definition three-dimensional manometry showing the lower esophageal sphincter before and after peroral endoscopic myotomy. The Annals of Thoracic Surgery 2016 101, 218-225DOI: (10.1016/j.athoracsur.2015.06.036) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions