TY - JOUR
T1 - Optical coherence tomography (OCT) prior to peroral endoscopic myotomy (POEM) reduces procedural time and bleeding
T2 - a multicenter international collaborative study
AU - Desai, Amit P.
AU - Tyberg, Amy
AU - Kedia, Prashant
AU - Smith, Michael S.
AU - Martinez, Guadalupe
AU - Zamarripa, Felipe
AU - Schneider, Yecheskel
AU - Bertani, Helga
AU - Frazzoni, Marzio
AU - Casas, Fernando
AU - Khanna, Lauren G.
AU - Lambroza, Arnon
AU - Kumta, Nikhil A.
AU - Khan, Ali
AU - Sharaiha, Reem Z.
AU - Salgado, Sanjay
AU - Gaidhane, Monica
AU - Sethi, Amrita
AU - Kahaleh, Michel
N1 - Publisher Copyright:
© 2016, Springer Science+Business Media New York.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - 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.
AB - 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.
KW - Achalasia
KW - Endoflip
KW - Lower esophageal sphincter
KW - OCT
KW - Optical coherence tomography
KW - Peroral endoscopic myotomy
UR - https://www.scopus.com/pages/publications/84964025980
U2 - 10.1007/s00464-016-4859-0
DO - 10.1007/s00464-016-4859-0
M3 - Article
C2 - 27059973
AN - SCOPUS:84964025980
SN - 0930-2794
VL - 30
SP - 5126
EP - 5133
JO - Surgical Endoscopy and Other Interventional Techniques
JF - Surgical Endoscopy and Other Interventional Techniques
IS - 11
ER -