ABSTRACT
BACKGROUND: Diverticular peroral endoscopic myotomy (POEM) is an alternative to surgery for the management of symptomatic thoracic esophageal diverticula. Conventionally, this requires proximal tunnel formation but a direct approach may simplify the technique. Herein, we report the outcomes of direct diverticular-POEM (DD-POEM). METHODS: We conducted a single-center prospective observational study evaluating DD-POEM. This involved a direct approach to the diverticulum. Success was defined as an Eckardt score of ≤â3 without the need for reintervention. RESULTS: 10 patients underwent DD-POEM (median age 72 years; interquartile range [IQR] 14.3; male 60â% [nâ=â6]). Median diverticulum size was 40âmm (IQR 7.5) and median location was 35âcm from the incisors (IQR 8.3). Five patients (50â%) had an underlying dysmotility disorder. The median procedure duration was 60 minutes (IQR 28.8). There were no adverse events. The median hospital stay was 1 day (IQR 0.75). The pre-procedure median Eckardt score of 6 (IQR 4) significantly improved to 0 (IQR 0.75; Pâ<â0.001) at a median follow-up of 14.5 months (IQR 13.8). Success was achieved in all patients. CONCLUSIONS: DD-POEM was a safe technique for the management of thoracic esophageal diverticula. Owing to its simplicity and excellent performance it should be further evaluated for the treatment of this disorder.
Subject(s)
Digestive System Surgical Procedures , Diverticulum, Esophageal , Esophageal Achalasia , Myotomy , Natural Orifice Endoscopic Surgery , Aged , Humans , Male , Diverticulum, Esophageal/surgery , Esophageal Achalasia/surgery , Esophageal Sphincter, Lower/surgery , Myotomy/methods , Natural Orifice Endoscopic Surgery/methods , Treatment Outcome , Prospective StudiesSubject(s)
Endoscopic Mucosal Resection , Gastrointestinal Stromal Tumors , Stomach Neoplasms , Humans , Gastrointestinal Stromal Tumors/diagnostic imaging , Gastrointestinal Stromal Tumors/surgery , Gastrointestinal Stromal Tumors/pathology , Endoscopy , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , GastroscopyABSTRACT
A 71-year-old female presented with nausea, emesis, early satiety, and abdominal distension following revascularization for chronic mesenteric ischemia. Computed tomography angiogram showed gastric dilatation. Esophagogastroduodenoscopy, small bowel follow through, and paraneoplastic panel were negative. Gastric emptying was delayed. Despite conservative management, she required a percutaneous endoscopic jejunostomy. The development of a prolonged gastroparetic state has not been previously described.
