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Diab ARF, Sujka JA, Nashit M, Abdel-Khalek A, Seth S, Docimo S, DuCoin CG. The Use of Knives With Versus Without Integrated Water-jet Function During Peroral Endoscopic Myotomy for Patients With Achalasia: A Meta-analysis. Surg Laparosc Endosc Percutan Tech 2025; 35:e1356. [PMID: 39812005 DOI: 10.1097/sle.0000000000001356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Accepted: 12/20/2024] [Indexed: 01/16/2025]
Abstract
BACKGROUND Peroral endoscopic myotomy (POEM) is a well-established endoscopic treatment for achalasia, utilizing an endoscopic knife for dissection. Recently, new knives with an integrated water-jet (WJ) function have been introduced. This study aims to compare the technical, perioperative, and late postoperative outcomes between WJ knives and conventional (C) knives, which lack the WJ function, through a pairwise meta-analysis of published comparative studies. METHODS We conducted a systematic literature review following PRISMA guidelines to identify studies directly comparing knives with versus without a WJ function in POEM for achalasia. A random-effects model was employed, using odds ratios for dichotomous data and mean differences for continuous data as effect size metrics. RESULTS The use of WJ knives demonstrated statistically significant reductions in the mean number of intraoperative instrument exchanges, mean intraoperative use of coagulation forceps, and operative times compared to the use of C knives. There were no significant differences in terms of the incidence of adverse events, subcutaneous emphysema, or mean hospital length of stay (LOS). Clinical success, defined as a postoperative Eckardt score <3, mean postoperative Eckardt scores, and the incidence of GERD requiring proton pump inhibitors (PPI) also showed no significant differences. CONCLUSIONS The use of water-jet (WJ) knives demonstrates comparable efficacy to conventional (C) knives, with superior efficiency reflected in reduced operative time and fewer intraoperative instrument exchanges. In addition, in terms of safety, the lower use of coagulation forceps with WJ knives suggests reduced intraoperative bleeding. However, no significant differences were observed between the groups in terms of length of stay (LOS) and adverse events, despite a trend toward reduction. A larger number of studies with greater sample sizes is required to better assess potential differences in safety between the use of WJ and C knives.
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Affiliation(s)
- Abdul-Rahman F Diab
- University of Central Florida College of Medicine/HCA Healthcare GME Consortium, Ocala, FL
- Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Joseph A Sujka
- Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Muhammad Nashit
- University of Central Florida College of Medicine/HCA Healthcare GME Consortium, Ocala, FL
| | - Ameen Abdel-Khalek
- University of Central Florida College of Medicine/HCA Healthcare GME Consortium, Ocala, FL
| | - Sukriti Seth
- University of Central Florida College of Medicine/HCA Healthcare GME Consortium, Ocala, FL
| | - Salvatore Docimo
- Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Christopher G DuCoin
- Department of Surgery, Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, Tampa, FL
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Ching Hui Yee C, Youssef M, Woo M, Bechara R. Peroral endoscopic myotomy for complex achalasia and the POEM difficulty score: An update. DEN OPEN 2025; 5:e70055. [PMID: 39866807 PMCID: PMC11757024 DOI: 10.1002/deo2.70055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 12/13/2024] [Accepted: 12/23/2024] [Indexed: 01/28/2025]
Abstract
Objectives We present an update on the (peroral endoscopic myotomy (POEM) difficulty score [PDS] by introducing a novel knife with waterjet functionality. Methods This is a retrospective review of patients who underwent POEM between May 2018 and July 2023 at the Kingston Health Sciences Center. Demographic and procedural variables were compared using descriptive and inferential statistics. Results One hundred thirty-nine consecutive POEMs were included in the study. Seventy-four (56.7% male; aged 56.7 ± 16.5 years) complex achalasia (CA) and 65 (55.4% female; aged 47.3 ± 20.2 years) non-CA POEM procedures were performed. PDS correlates moderately with procedural efficiency with a correlation coefficient of 0.595 (Spearman's p < 0.001). The mean efficiency for non-CA was 3.3 ± 1.2 min/cm compared to CA as follows: type III 3.3 ± 1.3 min/cm; prior myotomy 5.3 ± 2.3 min/cm; ≧4 prior procedures 4.0 ± 1.7 min/cm; sigmoid type 5.2 ± 2.4 min/cm. The median PDS for non-CA was 1 (1-5). In comparison, the median PDS for CA is as follows: type III 3 (2-4); prior myotomy 4 (3-5); ≧4 prior procedures 3 (1.25-4); sigmoid type 3 (2-4). PDS excluding the presence of spastic contractions correlated better with procedural velocity, with a correlation coefficient of 0.645 (Spearman's p < 0.001). Conclusions PDS continues to moderately correlate with procedural efficiency using the novel knife. The presence of spastic contractions correlated poorly with procedural efficiency. Thus, it may be omitted in further studies.
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Affiliation(s)
| | - Michael Youssef
- Department of Internal MedicineUniversity of TorontoTorontoOntarioCanada
| | - Matthew Woo
- Division of GastroenterologyDepartment of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Robert Bechara
- Division of GastroenterologyDepartment of MedicineQueen's UniversityKingstonOntarioCanada
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Yewale R, Daphale A, Gandhi A, Bapaye A. Prevention, detection and management of adverse events of third-space endoscopy. Indian J Gastroenterol 2024; 43:872-885. [PMID: 39259447 DOI: 10.1007/s12664-024-01665-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 07/29/2024] [Indexed: 09/13/2024]
Abstract
Third space endoscopy (TSE) or sub-mucosal endoscopy using a mucosal flap valve (SEMF) enables the endoscopist to operate in the deeper layers of the gastrointestinal tract or gain access to the mediastinal/peritoneal cavity for natural orifice transoral endoscopic surgery (NOTES). TSE procedures are essentially endoscopic surgical procedures with a variable learning curve. Adverse events (AEs) during TSE are specific and follow a certain pattern across the spectrum of TSE procedures. These can be broadly categorized according to either type of AE, time of presentation relative to the procedure or according to degree of severity. Three major categories of AEs encountered during TSE include insufflation related AEs, mucosal injuries (MIs) and bleeding. Other relevant AEs include infectious complications, aspiration pneumonia, post-procedural chest/abdominal pain, atelectasis, cardiac arrhythmias, pleural effusion and pulmonary embolism. Reported incidence of AEs during TSE procedures varies according to the type and complexity of procedure. Acquaintance regarding potential risk factors, technical tips and precautions, alarm signs for early recognition, assessment of degree of severity, morphological characterization of AEs and finally, expeditious selection of appropriate management strategy are crucial and imperative for successful clinical outcomes. The current review discusses the current evidence and practical guidelines for prevention, early detection and management of TSE-related AEs.
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Affiliation(s)
- Rohan Yewale
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune, 411 004, India
| | - Amit Daphale
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune, 411 004, India
| | - Ashish Gandhi
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune, 411 004, India
| | - Amol Bapaye
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune, 411 004, India.
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Kimoto Y, Inoue H, Shimamura Y, Azuma D, Ushikubo K, Yamamoto K, Okada H, Nishikawa Y, Tanaka I, Jandee S, Navarro MJ, Onimaru M. Hood-attached versus conventional triangular tip-jet knife in peroral endoscopic myotomy: a propensity score matching cohort study. Gastrointest Endosc 2024; 99:688-693. [PMID: 38065514 DOI: 10.1016/j.gie.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 04/24/2024]
Abstract
BACKGROUND AND AIMS Peroral endoscopic myotomy (POEM) is a safe and effective endoscopic treatment for achalasia and other esophageal motility disorders, and a versatile knife (TriangleTipKnife J [TTJ]; Olympus, Tokyo, Japan) is currently widely used in POEM. Recently, we reported a novel modification of TTJ, which was adjusted to a knife length of 2 mm by attaching a disposable clip (QuickClip Pro; Olympus) sheath to the tip as a hood attachment. This study compares the safety and effectiveness of TTJ and TTJ with a hood attachment (TTJ-H) in POEM. METHODS This 1:1 propensity score-matched retrospective cohort study compared the procedure time, myotomy efficiency, number of coagulation forceps usage, adverse events, length of hospital stay after POEM, procedural success, and clinical success between the TTJ and TTJ-H groups. RESULTS A total of 682 consecutive patients who underwent POEM between January 2021 and June 2023 were examined. We excluded 134 patients who had already undergone POEM or laparoscopic Heller myotomy as prior myotomy. Finally, 98 propensity score-matched pairs (n = 196) were identified. The mean procedure time was shortened from 93.5 minutes to 80.2 minutes (14% reduction, P = .012) when comparing the TTJ-H group versus the TTJ group. The mean myotomy efficiency was improved from 2.76 min/cm to 2.32 min/cm (16% improvement, P ≤ .001), and usage of coagulation forceps for hemostasis was decreased from 3.87 to .55 (86% reduction, P ≤ .001). CONCLUSIONS This study showed that use of TTJ-H could reduce total procedure time, improve myotomy efficiency, and reduce costs compared with TTJ.
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Affiliation(s)
- Yoshiaki Kimoto
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
| | - Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yuto Shimamura
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Daisuke Azuma
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Kei Ushikubo
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Kazuki Yamamoto
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Hiroki Okada
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yohei Nishikawa
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Ippei Tanaka
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Sawangpong Jandee
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan; Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand
| | - Marc Julius Navarro
- Institute of Digestive and Liver Diseases, St. Luke's Medical Center, Quezon City, Philippines
| | - Manabu Onimaru
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
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Inoue H, Kimoto Y, Navarro MJ, Nishikawa Y, Shimamura Y. Triangle-tip jet knife with hood attachment: novel modification to endoscopic knife. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:383-384. [PMID: 37849777 PMCID: PMC10577583 DOI: 10.1016/j.vgie.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Video 1Triangle-tip jet knife with hood attachment: a novel modification over existing endoscopic knife.
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Affiliation(s)
- Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yoshiaki Kimoto
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Marc Julius Navarro
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yohei Nishikawa
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yuto Shimamura
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
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Belopolsky Y, Puli SR. Water-jet vs traditional triangular tip knife in peroral endoscopic myotomy for esophageal dysmotility: A systemic review and meta-analysis. World J Gastrointest Endosc 2022; 14:608-615. [PMID: 36303808 PMCID: PMC9593513 DOI: 10.4253/wjge.v14.i10.608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/03/2022] [Accepted: 09/06/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Peroral endoscopic myotomy is an increasingly used less invasive modality to treat esophageal dysmotility. Recently, triangular tip knife with integrated water jet function has been introduced to mitigate multiple instrument exchanges.
AIM To compare traditional triangular tip knife and water jet knife in terms of procedural success, duration, instrument exchanges, coagulation forceps use, and adverse events.
METHODS We conducted a systemic review and meta-analysis with two authors independently in electronic databases (PubMed, Embase, and Cochrane Library) from inception through May 2021. In addition, we conducted a relevant search by Reference Citation Analysis (RCA) (https://www.referencecitationanalysis.com). A fixed-effects model was used to calculate weighted mean, odds ratio (OR), and confidence intervals (CI).
RESULTS We included 7 studies involving 558 patients. Triangular knife and water jet knife were similar in odds of procedural success with ratio of 4.78 (95%CI = 0.22-102.47) and odds of clinical success with ratio of 0.93 (95%CI = 0.29-2.97), respectively. Water jet knife had fewer instrument exchanges compared to triangular knife (2.21, 95%CI = 1.98-2.45 vs 11.9, 95%CI = 11.15-12.70) and usage of coagulation forceps (1.75, 95%CI = 1.52-1.97 vs 2.63, 95%CI = 2.37-2.89). Adverse events were higher in triangular knife group (OR: 2.30, 95%CI = 1.35-3.95).
CONCLUSION Peroral endoscopic myotomy using water jet knife is comparable in terms of procedural success to triangular tip knife. Water jet knife also required shorter procedural duration, less instrument exchanges, coagulation devices, and overall adverse events.
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Affiliation(s)
- Yuliya Belopolsky
- Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61605, United States
| | - Srinivas R Puli
- Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61605, United States
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Nabi Z, Reddy DN. New Kid on the Block: “Speedboat”. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1749335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
AbstractInnovations in devices and techniques have parallelly propelled the field of therapeutic endoscopy in gastrointestinal tract. With the development of endoscopic resection techniques and the availability of newly designed electrosurgical knives, the minimally invasive management of early gastrointestinal neoplasms has revolutionized. The currently available electrosurgical knives are monopolar devices, not equipped with injection needle and required to be exchanged with coagulation forceps for hemostasis. Monopolar electrosurgical devices require higher voltages with associated risks. A recent innovation in the field of endoscopic knives is a new device called “Speedboat” device, specially designed for use in endoscopic dissection procedures. This is a bipolar device that utilizes radio frequency energy for cutting and microwave energy for achieving hemostasis. Speedboat device possesses hemostasis capability and has an integrated injection needle that imparts an “all-in-one” quality to this device. Preliminary data suggest the safety and utility of this device in performing a variety of endoscopic dissection and resection procedures including endoscopic submucosal dissection, per-oral endoscopic myotomy, and resection of subepithelial tumors.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad, Telangana, India
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Motomura D, Hew S, Bechara R. Novel triangle tip-jet knife increases efficiency in peroral endoscopic myotomy for achalasia. JGH Open 2021; 5:1142-1147. [PMID: 34621999 PMCID: PMC8485410 DOI: 10.1002/jgh3.12638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 12/21/2022]
Abstract
Background and Aim Peroral endoscopic myotomy (POEM) is performed globally for the treatment of achalasia. A newly available endoscopic knife, the triangle tip‐jet (TTJ) (Olympus Triangle TipKnife‐J, KD‐645L), has the capability of knife dissection along with submucosal injection. We aim to present our experience with the TTJ knife in comparison to the conventional TT knife in POEM, with a focus on procedural characteristics including time, efficiency, and the number of instrument exchanges. Methods All patients with achalasia who underwent POEM between March 2016 and March 2020 at a single tertiary academic center were included in the retrospective cohort. Demographic, procedural, and outcomes data were compared. Results Ninety‐two procedures, 48 using the TT knife, and 44 with the TTJ knife were analyzed. Demographic data were similar. Procedure time was reduced using the TTJ knife (87 vs 61 min, P = <0.001) despite similar myotomy lengths (16.5 vs 15.2 cm, P = 0.09). Efficiency was increased in the TTJ group (5.5 vs 4.3 min/cm of procedure, P = 0.005). The number of instrument exchanges (16.7–1.7, P = <0.001) and usage of coagulation forceps decreased (1.7–0.5, P = <0.001). There was no difference in the procedural difficulty (POEM difficulty score [PDS] 2.2 vs 2.4, P = 0.4). Patients with higher procedural difficulty saw a greater improvement in procedural outcomes. Procedural success was high in both groups (96% vs 100%, P = 0.2). No serious adverse events were reported. Conclusions The use of the TTJ knife increases efficiency during POEM for Achalasia. The total procedure time is decreased by 28–41%, and procedural efficiency is increased by 22–34%.
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Affiliation(s)
- Douglas Motomura
- Gastroenterology Department Kingston Health Sciences Centre Kingston Ontario Canada
| | - Simon Hew
- Department of Gastoenterology Monash Health Melbourne Victoria Australia
| | - Robert Bechara
- Gastroenterology Department Kingston Health Sciences Centre Kingston Ontario Canada
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Nabi Z, Chavan R, Ramchandani M, Tsiamoulos Z, Basha J, Goud R, Darisetty S, Reddy N. Endoscopic submucosal dissection and tunneling procedures using a novel all-in-one bipolar device. Endosc Int Open 2020; 8:E1302-E1307. [PMID: 33015331 PMCID: PMC7511265 DOI: 10.1055/a-1220-6562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/22/2020] [Indexed: 12/24/2022] Open
Abstract
Background and study aims Recent innovations in devices and techniques have revolutionized the field of endoscopic resection procedures. In this study, we evaluated the safety and feasibility of endoscopic submucosal dissection and tunneling procedures with a novel, multipurpose bipolar device. Patients and methods Data from consecutive patients who underwent per-oral endoscopic myotomy (POEM), submucosal tunneling endoscopic resection (STER), and endoscopic submucosal dissection (ESD) using a novel bipolar device (December 2019 to February 2020) were analyzed retrospectively. Procedure duration, technical success, and adverse events (AEs) were recorded. Results A total of 10 procedures were performed using the novel bipolar device during the study period. The procedures included POEM (n = 7), STER for esophageal sub-epithelial tumor (n = 1), ESD for rectal polyp (n = 1), and gastric neuroendocrine tumor (n = 1). POEM was successfully completed in all patients. In patients who underwent STER and ESD, en-bloc resection was achieved in all. Mean procedure time for submucosal tunneling procedures (POEM and STER) was 59.12 ± 31.12 minutes. The procedures were completed without the requirement for exchange of accessories in eight cases (80 %). There were no major AEs. Mild and moderate AEs occurred during POEM and included capno-peritoneum (n = 1), retroperitoneal CO 2 (n = 1), and empyema (n = 1). Conclusion ESD and tunneling procedures can be safely performed without the need for exchange of accessories using a novel bipolar device. Randomized comparison with conventional knives isrequired to confirm the utility of this device.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology – Medical Gastroenterology, Hyderabad, India
| | - Radhika Chavan
- Asian Institute of Gastroenterology – Gastroenterology, Hyderabad, India
| | - Mohan Ramchandani
- Asian Institute of Gastroenterology – Gastroenterology, Hyderabad, India
| | | | | | - Rajesh Goud
- Asian Institute of Gastroenterology – Gastroenterology, Hyderabad, India
| | - Santosh Darisetty
- Asian Institute of Gastroenterology – Gastroenterology, Hyderabad, India
- Asian Institute of Gastroenterology – Anesthesia, Hyderabad, India
| | - Nageshwar Reddy
- Asian Institute of Gastroenterology – Gastroenterology, Hyderabad, India
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Nabi Z, Chavan R, Ramachandani M, Darisetty S, Reddy DN. Peroral endoscopic myotomy in a patient with failed Heller's myotomy by use of a novel bipolar radiofrequency device. VideoGIE 2020; 5:138-140. [PMID: 32258841 PMCID: PMC7125408 DOI: 10.1016/j.vgie.2019.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad, India
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Nabi Z, Ramchandani M, Jagtap N, Darisetty S, Reddy DN. Endoscopic treatment of Zenker's diverticulum using a new triangle tip knife. Ann Gastroenterol 2019; 32:650-653. [PMID: 31700244 PMCID: PMC6826068 DOI: 10.20524/aog.2019.0393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/11/2019] [Indexed: 01/01/2023] Open
Abstract
Background: Zenker’s diverticulum (ZD) is a rare disease that affects elderly subjects. The mainstay of management is endoscopic myotomy of the cricopharyngeal septum. In this series, we aimed to evaluate the feasibility and efficacy of cricopharyngeal myotomy with a new electrosurgical knife in patients with ZD. Methods: Consecutive patients with ZD who underwent flexible endoscopic myotomy with the new triangle tip knife J (TTJ) were included in the study. The study outcomes included technical and clinical success, procedure duration, and adverse events. Results: A total of 7 patients [median age 57 (range 40-87) years] underwent cricopharyngeal myotomy with the TTJ knife. The median size of the ZD was 4 (range 3-5) cm. The procedure was successfully completed in all the patients with a median operative time of 12 (range 8-16) min. There were no major adverse events. Minor bleeding was noticed in 3 patients and was successfully managed using the same knife. Clinical resolution of symptoms was noticed in all the patients at follow up. Conclusion: Cricopharyngeal myotomy can be performed safely and efficiently with the new TTJ knife.
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Affiliation(s)
- Zaheer Nabi
- Gastroenterology Department, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mohan Ramchandani
- Gastroenterology Department, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nitin Jagtap
- Gastroenterology Department, Asian Institute of Gastroenterology, Hyderabad, India
| | - Santosh Darisetty
- Gastroenterology Department, Asian Institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Gastroenterology Department, Asian Institute of Gastroenterology, Hyderabad, India
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Abstract
PURPOSE OF REVIEW Peroral endoscopic myotomy (POEM) and gastric peroral endoscopic myotomy (G-POEM) are minimally invasive endoscopic procedures for the treatment of esophageal motility disorders and refractory gastroparesis, respectively. In this review, we highlight the most recent publications on the technical aspects of POEM and G-POEM. RECENT FINDINGS POEM has evolved into a standard therapeutic option in patients with all achalasia subtypes with excellent durability and safety profile. G-POEM is a novel endoscopic procedure with promising results in terms of efficacy, safety, and symptom improvement in patients with refractory gastroparesis. SUMMARY POEM and G-POEM are novel endoscopic procedures. Practice patterns vary among endoscopists and procedure techniques continue to evolve. Comparative studies examining outcomes of different techniques are needed.
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Khashab MA. Peroral endoscopic myotomy using tailored accessories. Saudi J Gastroenterol 2018; 24:1-2. [PMID: 29451176 PMCID: PMC5848317 DOI: 10.4103/sjg.sjg_488_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland, USA,Address for correspondence: Prof. Mouen A. Khashab, Johns Hopkins Hospital, 1800 Orleans Street, Sheikh Zayed Tower, Baltimore, Maryland, USA. E-mail:
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