Optical coherence tomography (OCT) prior to peroral endoscopic myotomy (POEM) reduces procedural time and bleeding: a multicenter international collaborative study

Amit P. Desai, Amy Tyberg, Prashant Kedia, Michael S. Smith, Guadalupe Martinez, Felipe Zamarripa, Yecheskel Schneider, Helga Bertani, Marzio Frazzoni, Fernando Casas, Lauren G. Khanna, Arnon Lambroza, Nikhil A. Kumta, Ali Khan, Reem Z. Sharaiha, Sanjay Salgado, Monica Gaidhane, Amrita Sethi, Michel Kahaleh

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background: Per-oral endoscopic myotomy (POEM) has emerged as an endoscopic treatment of achalasia. There are no pre-procedural imaging modalities to predict the safest and the most efficacious approach. Aim: To evaluate the use of optimal coherence tomography (OCT) in providing a pre-procedural esophageal assessment. Methods: Patients undergoing POEM from July 2013 to November 2015 were captured in a multicenter, international registry. Patients who underwent OCT pre-POEM (“OCT arm”) were compared to patients without pre-POEM OCT (“control arm”). OCT images were assessed for the degree of vascularity and the thickness of the circular muscular layer, and an approach was determined. Results: A total of 84 patients were captured in the registry. Fifty-one patients underwent pre-POEM OCT. Using OCT as a guide, 24 (47 %) of patients underwent anterior POEM while 27 (53 %) underwent posterior POEM. Technical success was achieved in 96 % of patients. Significantly less bleeding occurred in the OCT arm when compared to the control group [4 (8 %) vs. 14 (43 %), p = 0.0001]. As a result, procedural time was significantly lower in the OCT group as compared to the control group (85.8 vs. 121.7 min, p = 0.000097). Conclusion: Pre-POEM OCT results in a reduction in procedural bleeding which contributes to a reduction in overall procedural time. Clinical trial registration: NCT01438385.

Original languageEnglish
Pages (from-to)5126-5133
Number of pages8
JournalSurgical Endoscopy and Other Interventional Techniques
Volume30
Issue number11
DOIs
StatePublished - 1 Nov 2016
Externally publishedYes

Keywords

  • Achalasia
  • Endoflip
  • Lower esophageal sphincter
  • OCT
  • Optical coherence tomography
  • Peroral endoscopic myotomy

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