Journal Review in Thoracic Surgery: POEM vs. Heller Myotomy

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 18 July 2022

⏱️ 30 minutes

🔗️ Recording | iTunes | RSS

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Summary

Want to learn more about achalasia and its procedural management? Excited about the POEM procedure? Learn what the current literature says when it comes to recommending POEM or the tried-and-true Heller myotomy from the Swedish Thoracic surgery team.

Learning objectives
- Review basics of achalasia
- Discuss the current literature comparing POEM and Heller myotomy with fundoplication
- Understand the major differences in outcomes for these procedures

Hosts:
Peter White, MD
Megan Lenihan, MD
Brian Louie, MD
Kelly Daus, MD

Referenced Material
Werner YB, Hakanson B, Martinek J, et al. Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. N Engl J Med. 2019 Dec 5;381(23):2219-2229. doi: 10.1056/NEJMoa1905380. PMID: 31800987.

Gu L, Ouyang Z, Lv L, et al. Safety and efficacy of peroral endoscopic myotomy with standard myotomy versus short myotomy for treatment-naïve patients with type II achalasia: a prospective randomized trial. Gastrointest Endosc. 2021 Jun;93(6):1304-1312. doi: 10.1016/j.gie.2020.10.006. Epub 2020 Oct 13. PMID: 33058884.

Shemmeri E, Aye RW, Farivar AS, Bograd AJ, Louie BE. Use of a report card to evaluate outcomes of achalasia surgery: beyond the Eckardt score. Surg Endosc. 2020 Apr;34(4):1856-1862. doi: 10.1007/s00464-019-06952-2. Epub 2019 Jul 8. PMID: 31286258.

Mota RCL, de Moura EGH, de Moura DTH, Bernardo WM, de Moura ETH, Brunaldi VO, Sakai P, Thompson CC. Risk factors for gastroesophageal reflux after POEM for achalasia: a systematic review and meta-analysis. Surg Endosc. 2021 Jan;35(1):383-397. doi: 10.1007/s00464-020-07412-y. Epub 2020 Mar 23. PMID: 32206921.

McKay SC, Dunst CM, Sharata AM, Fletcher R, Reavis KM, Bradley DD, DeMeester SR, Müller D, Parker B, Swanström LL. POEM: clinical outcomes beyond 5 years. Surg Endosc. 2021 Oct;35(10):5709-5716. doi: 10.1007/s00464-020-08031-3. Epub 2021 Jan 4. PMID: 33398572.

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Transcript

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0:00.0	Hi Anna. Hi Anna. Hi Anna. Do you have a dilemma that makes you feel totally alone?
0:05.4	Well, the good news is it's not just you. I'm earning more money than him now and I don't think he likes it.
0:11.4	We've been sleeping together for the past few weeks, but she has a boyfriend.
0:14.9	I am a virgin, I am 25. And I'm just not sure if it's normal.
0:19.6	I'm Anna Richardson and this is it can't just be me when no topic is off limits.
0:25.0	Find it wherever you're listening to this or on it can't just be me dot co dot UK.
0:36.0	Behind the night, the surgery podcast relevant and engaging content designed to help you dominate the day.
0:43.1	Welcome back to another journal club with your thoracic surgery team from Swedish Medical Center.
0:57.2	I'm Megan Lennahan and as always, I'm joined by the esteemed doctors Brian Louis and Peter White.
1:04.5	We are lucky enough to also have Kelly Dawes here, a newly minted second year resident who is
1:09.6	interested in cardiothoracic surgery. She's going to help us explore our topic and today,
1:14.7	we will be talking about procedural management of acoolagia, specifically making the decision
1:20.4	between heller myotomy with partial fund application and per oral and escapic myotomy also known as
1:26.6	poem. So let's start off with the case. All right, so you see a 50 year old otherwise healthy man
1:34.4	and clinic referred by his PCP for dysphagia. He's had three to four years of food getting stuck in
1:39.8	his chest most days. He feels a pressure. He regurgitates two to three times a week. He tells you
1:46.8	this long story about how he has to get up when he eats and walk around and flap his arms and
1:51.6	jump up and down. And initially it was just to solids, but it's progressed and now he's having
1:57.3	trouble getting liquids down as well. So Kelly, obviously this is an acoolagia talk you know where I'm
2:03.6	headed. But before we get there, what other things are on your differential? Although it's a longer
2:09.7	time frame of progressive symptoms, dysphagias always alarm symptom and cancer has to be considered.
2:16.2	There's also hyalurneas, gourd, orange, hensic, esophageal, dysmatilities like eosinophilic esophageitis
	...

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