Guest guest Posted January 29, 2012 Report Share Posted January 29, 2012 I was told that this approach only has about a 10 percent success rate. Sent from my iPhone On Jan 29, 2012, at 10:48, " jacquieheys " <jaxheys@...> wrote: > POEM is an endoscopic Heller Myotomy (so to speak). No cuts through the abdomen. All access is down through the gullet. > > More information (including a video of one being performed): > > http://daveproject.org/endoscopic-myotomy-for-the-treatment-of-achalasia/2010-05\ -03/ > > http://www.facs.org/surgerynews/update/poem1110.html > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2012 Report Share Posted January 29, 2012 , any idea why? > > > POEM is an endoscopic Heller Myotomy (so to speak). No cuts through the abdomen. All access is down through the gullet. > > > > More information (including a video of one being performed): > > > > http://daveproject.org/endoscopic-myotomy-for-the-treatment-of-achalasia/2010-05\ -03/ > > > > http://www.facs.org/surgerynews/update/poem1110.html > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2012 Report Share Posted January 29, 2012 My surgeon said that it is such a new surgery and they have not had that much data. He feels that because of the narrow operating view it hinders a proper surgery and gives low success outcomes. I just talked to him about this on Thursday when I had my follow up appointment. Sent from my iPhone On Jan 29, 2012, at 11:27, " jacquieheys " <jaxheys@...> wrote: > , any idea why? > > > > > > > POEM is an endoscopic Heller Myotomy (so to speak). No cuts through the abdomen. All access is down through the gullet. > > > > > > More information (including a video of one being performed): > > > > > > http://daveproject.org/endoscopic-myotomy-for-the-treatment-of-achalasia/2010-05\ -03/ > > > > > > http://www.facs.org/surgerynews/update/poem1110.html > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2012 Report Share Posted January 29, 2012 Agree with your surgeon. The only data @ present is from Japan. There is a small series from the US just published last month - 5 patients. The sample size is too small to make any recommendations. Lap Heller still has the best long term outcome. Ziad Sent from my HTC on the Now Network from Sprint! ----- Reply message ----- From: " Mueller IV " <mt4mar@...> Date: Sun, Jan 29, 2012 11:42 Subject: Re: POEM surgery " achalasia " <achalasia > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2012 Report Share Posted January 29, 2012 I agree. Early diagnosis and proper surgery by a qualified surgeon is the best approach for long term management of a rare progressive disease. That and a strong determined mind for a complete recovery after surgery. Sent from my iPhone On Jan 29, 2012, at 11:53, " ziad_awad@... " <ziad_awad@...> wrote: > Agree with your surgeon. The only data @ present is from Japan. There is a small series from the US just published last month - 5 patients. The sample size is too small to make any recommendations. Lap Heller still has the best long term outcome. > > Ziad > > Sent from my HTC on the Now Network from Sprint! > > ----- Reply message ----- > From: " Mueller IV " <mt4mar@...> > Date: Sun, Jan 29, 2012 11:42 > Subject: Re: POEM surgery > " achalasia " <achalasia > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 Hi , I´m new here. Had HM with Toupet 2009 and feel fine. Why I answer is, that it isn't true with this 10%. All in the World there are more than 400 patient operated with POEM and the success rate is as with HM about 90% with a refluxrate of 10% (like with Heller, but they do no wrap!). The largest study was done in Japan with 100 + cases and a smaller study in Germany with 30 cases. But there are other center, which do POEM one in California (I think University of C.) one in Montral, Honkong.... It is clear that this is a fairly young methode (just somewhat more than 2 years and that means no real lonterm study!) Notan gave a link to an article on from a surgical magazine from August 2011 and commented as well. Cann´t find it at the moment. Excuse my english. a > > > > > POEM is an endoscopic Heller Myotomy (so to speak). No cuts through the abdomen. All access is down through the gullet. > > > > > > More information (including a video of one being performed): > > > > > > http://daveproject.org/endoscopic-myotomy-for-the-treatment-of-achalasia/2010-05\ -03/ > > > > > > http://www.facs.org/surgerynews/update/poem1110.html > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 I have spoke with a few surgeons about this method and they have leaned on the side of it not having a high success rate. Our disease is not well researched to begin with in the whole scope of things. I am glad you have added this information. I feel it is important to have as much information available so we can make better decisions about what course an individual will make. Sent from my iPhone On Jan 30, 2012, at 10:58, " dd.haas " <dd.haas@...> wrote: > Hi , > I´m new here. Had HM with Toupet 2009 and feel fine. > Why I answer is, that it isn't true with this 10%. > All in the World there are more than 400 patient operated with POEM and the success rate is as with HM about 90% with a refluxrate of 10% (like with Heller, but they do no wrap!). The largest study was done in Japan with 100 + cases and a smaller study in Germany with 30 cases. But there are other center, which do POEM one in California (I think University of C.) one in Montral, Honkong.... > It is clear that this is a fairly young methode (just somewhat more than 2 years and that means no real lonterm study!) > Notan gave a link to an article on from a surgical magazine from August 2011 and commented as well. Cann´t find it at the moment. > Excuse my english. > a > > > > > > > > > POEM is an endoscopic Heller Myotomy (so to speak). No cuts through the abdomen. All access is down through the gullet. > > > > > > > > More information (including a video of one being performed): > > > > > > > > http://daveproject.org/endoscopic-myotomy-for-the-treatment-of-achalasia/2010-05\ -03/ > > > > > > > > http://www.facs.org/surgerynews/update/poem1110.html > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 ten percent is pretty terrible.. kim bailey Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 3, 2012 Report Share Posted February 3, 2012 Hello all. I have been reading this group for some time and was surprised to see a discussion about POEM surgery as I have an appt tomorrow to discuss this option. Here's my history: I am a 52 yo male from New York and I was diagnosed with achalasia in 1990. Between 1990 and 1997 I had more dilations than I care to count. I finally agreed to surgery in 1997 since it would be done laparoscopically. I had a Heller's myotomy with a partial fundo and had relief for about 4 yrs. Unfortunately the symptoms returned over time and I had 2 or 3 dilations and for the past several years I go to the hospital every 4-5 mos for Botox injections. My GI has been having difficulty doing the endoscopy since there is so much food in my esophagus. It got so bad that about 9 months ago he hospitalized me so that my esophagus and stomach could be pumped and he could get a clear view of exactly where the injections should be given. My last Botox was this past Friday and as each nurse walked into the operating room they greeted me by first name. I told them as much as I enjoy talking with them, a hospital in NOT a place where I'm glad everyone knows my name!! Lol. I have an appt tomorrow at Winthrop hospital to discuss whether or not the new POEM procedure will do me any good. POEM generally isn't an option for someone who had a previous myotomy, however there have been limited cases where this has been done. Although I'm not expecting much, I am hopeful. I'm willing to try just about anything in the name of relief!!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2012 Report Share Posted February 4, 2012 Ron, do get back to us, and let us know! I'd be very curious as to *why* it might work, all things considered. If you were new to all this, and fearing scars, I'd suggest Rosemurgy and LESS, with no visible scars (done from *inside* the bellybutton. . . .). Best wishes! in the Wilds (of West Virginia) > > Hello all. I have been reading this group for some time and was surprised to see a discussion about POEM surgery as I have an appt tomorrow to discuss this option. > Here's my history: > > I am a 52 yo male from New York and I was diagnosed with achalasia in 1990. Between 1990 and 1997 I had more dilations than I care to count. I finally agreed to surgery in 1997 since it would be done laparoscopically. I had a Heller's myotomy with a partial fundo and had relief for about 4 yrs. Unfortunately the symptoms returned over time and I had 2 or 3 dilations and for the past several years I go to the hospital every 4-5 mos for Botox injections. My GI has been having difficulty doing the endoscopy since there is so much food in my esophagus. It got so bad that about 9 months ago he hospitalized me so that my esophagus and stomach could be pumped and he could get a clear view of exactly where the injections should be given. > > My last Botox was this past Friday and as each nurse walked into the operating room they greeted me by first name. I told them as much as I enjoy talking with them, a hospital in NOT a place where I'm glad everyone knows my name!! Lol. > > I have an appt tomorrow at Winthrop hospital to discuss whether or not the new POEM procedure will do me any good. POEM generally isn't an option for someone who had a previous myotomy, however there have been limited cases where this has been done. > > Although I'm not expecting much, I am hopeful. I'm willing to try just about anything in the name of relief!!!! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2012 Report Share Posted February 4, 2012 Information about the POEM surgery and achalasia can be found on Winthrop Hospital's web site linked below.  http://www.winthrop.org/departments/institutes/digestive/achalasia.cfm  ________________________________ From: King <rk405@...> achalasia Sent: Friday, February 3, 2012 9:51 PM Subject: POEM SURGERY  Hello all. I have been reading this group for some time and was surprised to see a discussion about POEM surgery as I have an appt tomorrow to discuss this option. Here's my history: I am a 52 yo male from New York and I was diagnosed with achalasia in 1990. Between 1990 and 1997 I had more dilations than I care to count. I finally agreed to surgery in 1997 since it would be done laparoscopically. I had a Heller's myotomy with a partial fundo and had relief for about 4 yrs. Unfortunately the symptoms returned over time and I had 2 or 3 dilations and for the past several years I go to the hospital every 4-5 mos for Botox injections. My GI has been having difficulty doing the endoscopy since there is so much food in my esophagus. It got so bad that about 9 months ago he hospitalized me so that my esophagus and stomach could be pumped and he could get a clear view of exactly where the injections should be given. My last Botox was this past Friday and as each nurse walked into the operating room they greeted me by first name. I told them as much as I enjoy talking with them, a hospital in NOT a place where I'm glad everyone knows my name!! Lol. I have an appt tomorrow at Winthrop hospital to discuss whether or not the new POEM procedure will do me any good. POEM generally isn't an option for someone who had a previous myotomy, however there have been limited cases where this has been done. Although I'm not expecting much, I am hopeful. I'm willing to try just about anything in the name of relief!!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2012 Report Share Posted February 4, 2012 wrote: > > Information about the POEM surgery and achalasia can be found on > Winthrop Hospital's web site linked below. > > http://www.winthrop.org/departments/institutes/digestive/achalasia.cfm > Thanks for the link. I didn't learn anything new about POEM but it did have some interesting statistics: " Surgery (laparoscopic Heller myotomy with Dor fundoplication) is effective but about 15- 20% of patients will eventually revert to balloon dilation due to relapse and up to a quarter of patients will have reflux symptoms. " And: " ... a serious complication known as “perforation†which occurs in 2-4% of patients undergoing balloon dilation and about 6% of patients undergoing laparoscopic Heller myotomy... " There are no footnotes to sources. These may be from their own practice. The reflux rate seems high. The perforation rates look about right. The thing to remember though is that having a perforation during surgery can be a lot less trouble than one caused by a dilatation. While most perforation are small a balloon can cause a nasty rip that requires emergency open chest surgery and this perforation could happen at an out patient center not a hospital operating room. Perforation while having a myotomy happens in the OR (or in a specialized surgical center) with the surgeon looking at the perforation. It is usually small and easy to fix, even if it is missed it will probably heal on its own because it is small. It also reminded me of a question I have about POEM that I guess time will tell. According to the article: " ... the tunnel collapses and completely seals the cut that was made in the sphincter muscle. This prevents any leak of esophageal contents ... " So, the collapses of the tunnel prevents problems from perforations. That is a good thing. My question is what happens at the LES where the muscle was cut (myotomy)? Does the muscle also collapses back together or does it pull away enough from itself? One of the claimed benefits of a toupet fundoplication after lap myotomy is that it holds the myotomy edges apart so the myotomy does not heal or scar back together as easily and cause myotomy failure. On the other hand, one of the benefits of Dor fundoplication, which goes over the lap myotomy, is that it covers any perforation there. I can't see from the data if the toupet is really doing much help in this way, but scarring and healing of the muscles is suppose to be one of the reasons for myotomy failure. It will be interesting to see how this plays out with POEM. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2012 Report Share Posted February 4, 2012 I wanted to jump in on this since I just discussed it with Dr. Melvin. According to him, the advantages of going down the throat are: no scars, much easier and faster recovery (just a sore throat for a few days as opposed to not being able to lift anything heavy for 2 weeks, etc), less chance of acid reflux and no need for a wrap since only the inside set of E muscles are cut and the outside set can still close off to keep stomach contents down. The risks of perforation are the same, the success rate is the same, and the degree of improvement in swallowing is the same. He did say that a possible downside is what may happen long term, since this is a new procedure. However, he said the worst that he could see happening is that several years down the road, the prodedure may need to be repeated or traditional heller myotomy may be necessary, but so far, there is no evidence of any such problems, and having the POEM procedure would not make a future HM less successful. I should also mention that Dr. Melvin flew to Japan and watched Dr. Inoue perform a few surgeries. (Dr. Inoue is the one who invented this technique....he says " POEM is the way of the future. " Now, I took all that with a grain of salt because he had the team of surgeons from Chicago coming to teach him how to do it and he really needed a guinea pig. I was happy to be that guinea pig, but like I said, it turns out I was not a candidate due to a sigmoid esophagus. I read everything I could find on POEM and so far the results seem very promising. I would have done it in a heartbeat. If your surgeon is offering you this option, I would recommend doing the research for yourself and see what you think. By the way, I'm 9 days post-op from my emergency HM and doing great! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 4, 2012 Report Share Posted February 4, 2012 Hi , POEM is not only " less scars " . It is a different approach and cuts only the ring muscle, which is the reason for the passage obstruction. And all is done endoscopically. The thing to consider is, that it is a new methode with only just above 2 years " longterm experience " . Until now, the results are as good as a HM with fundoplicatio (without the use of a wrap in this methode). a from Brazil > > > > Hello all. I have been reading this group for some time and was surprised to see a discussion about POEM surgery as I have an appt tomorrow to discuss this option. > > Here's my history: > > > > I am a 52 yo male from New York and I was diagnosed with achalasia in 1990. Between 1990 and 1997 I had more dilations than I care to count. I finally agreed to surgery in 1997 since it would be done laparoscopically. I had a Heller's myotomy with a partial fundo and had relief for about 4 yrs. Unfortunately the symptoms returned over time and I had 2 or 3 dilations and for the past several years I go to the hospital every 4-5 mos for Botox injections. My GI has been having difficulty doing the endoscopy since there is so much food in my esophagus. It got so bad that about 9 months ago he hospitalized me so that my esophagus and stomach could be pumped and he could get a clear view of exactly where the injections should be given. > > > > My last Botox was this past Friday and as each nurse walked into the operating room they greeted me by first name. I told them as much as I enjoy talking with them, a hospital in NOT a place where I'm glad everyone knows my name!! Lol. > > > > I have an appt tomorrow at Winthrop hospital to discuss whether or not the new POEM procedure will do me any good. POEM generally isn't an option for someone who had a previous myotomy, however there have been limited cases where this has been done. > > > > Although I'm not expecting much, I am hopeful. I'm willing to try just about anything in the name of relief!!!! > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 5, 2012 Report Share Posted February 5, 2012 Devin wrote: > > ... Dr. Melvin. According to him, the advantages of going down the > throat are:... > I would think there is another advantage that has not been mentioned. No adhesions! My guess is that because any scarring that occurs is going to be covered by muscle or is inside the esophagus, there would be no adhesions growing through the body and possibly binding organs together. Just my guess. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 7, 2012 Report Share Posted February 7, 2012 Yikes! Only 10% is not so good!  Kim A ________________________________ From: Mueller IV <mt4mar@...> " achalasia " <achalasia > Sent: Sunday, January 29, 2012 10:07 AM Subject: Re: POEM surgery  I was told that this approach only has about a 10 percent success rate. Sent from my iPhone On Jan 29, 2012, at 10:48, " jacquieheys " <jaxheys@...> wrote: > POEM is an endoscopic Heller Myotomy (so to speak). No cuts through the abdomen. All access is down through the gullet. > > More information (including a video of one being performed): > > http://daveproject.org/endoscopic-myotomy-for-the-treatment-of-achalasia/2010-05\ -03/ > > http://www.facs.org/surgerynews/update/poem1110.html > > Quote Link to comment Share on other sites More sharing options...
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