Re: Re: POEM/TEEM concerns

[Guest guest]

wrote:

>

> I think there is just a lot of misconception. There is not actually a

> hole made thru the entire E, it is made between the tissue layers ,in

> the form of a tunnel, and then they move a few cm down to the GE

> junction and start snipping away.

>

They have to make a hole (incision) somewhere so that they can get to

the muscle layers of the esophagus. You can do that by making holes in

the stomach (lap), chest or neck (Thoracoscopy) or you can go into the

muscle layer by making a hole in the inside of the esophagus (POEM and

TEEM). The holes, where ever they are made are stitched up when finished.

notan

[Guest guest]

wrote:

>

> I think there is just a lot of misconception. There is not actually a

> hole made thru the entire E, it is made between the tissue layers ,in

> the form of a tunnel, and then they move a few cm down to the GE

> junction and start snipping away.

>

Notan Wrote:

<They have to make a hole (incision) somewhere so that they can get to

<the muscle layers of the esophagus. You can do that by making holes in

<the stomach (lap), chest or neck (Thoracoscopy) or you can go into the

<muscle layer by making a hole in the inside of the esophagus (POEM and

<TEEM). The holes, where ever they are made are stitched up when finished.

 

But Notan, the hole is not made through te entire wall (all layers) of the

esophagus and this is, what said.

With the infection side you mention " there seems to be no concern " ;- yes! The

incisionsite will be desinfekted (? is this the right english term) before

incision and you get after the proceedure antibiotics iv the first 1 or 2

day, then oral for a short time.

I often think surgens, which do not yet perform this methode, will tell only the

negative side of POEM. If they would tell all, even the minute risks of lap Myo,

a lot of us achalasians wouldn´t go for it either. As said, Medicine

changes and if no new methods and their " guinea pigs " would be there, there

would still be the time of medieval age.

 

By the way, there was a course beginning of march, the society of american

gastrointestinal surgens (SAGES) gave, with Prof Inoue from Japan (who did

already more than 150 cases). There is a good PDF site, with the autors (Inoue)

personal copy of an article in Thorac Surg Clin 21, were he bescribes the

methode and the outcome on his " first 104 patients " . Good inustrations an

explanations!

 

a

 

 

[Guest guest]

a wrote:

>

>

> But Notan, the hole is not made through te entire wall (all layers) of

> the esophagus and this is, what said.

>

I could not tell if " hole " in the discussion meant " hole into " or " hole

through. " I meant hole into.

> With the infection side you mention " there seems to be no concern " ;-

> yes! The incisionsite will be desinfekted (? is this the right english

> term) before incision and you get after the proceedure antibiotics iv

> the first 1 or 2 day, then oral for a short time.

>

Hopefully there would have been nothing in the mouth or esophagus that

was resistant to the antibiotics that they used. Time will tell if this

is a problem or not. I don't think enough cases have been done to know

if is.

>

> I often think surgens, which do not yet perform this methode, will

> tell only the negative side of POEM. If they would tell all, even the

> minute risks of lap Myo, a lot of us achalasians wouldn´t go for it

> either.

>

Maybe, but I don't find that fair. We don't know yet for POEM what is an

important small risk and what is an unimportant small risk. I assume the

infection risk is small, I don't assume whether it is important or not.

I wait to see.

> As said, Medicine changes and if no new methods and their

> " guinea pigs " would be there, there would still be the time of

> medieval age.

>

I am happy some people are willing to be guinea pigs if they are fully

informed.

>

> By the way, there was a course beginning of march, the society of

> american gastrointestinal surgens (SAGES) gave, with Prof Inoue from

> Japan (who did already more than 150 cases). There is a good PDF site,

> with the autors (Inoue) personal copy of an article in Thorac Surg

> Clin 21, were he bescribes the methode and the outcome on his " first

> 104 patients " . Good inustrations an explanations!

>

Not enough cases and not by enough independent sources to confirm the value.

notan

[Guest guest]

Notan wrote:<Maybe, but I don't find that fair. We don't know yet for POEM what

is an <important small risk and what is an unimportant small risk. I assume

the <infection risk is small, I don't assume whether it is important or not. <I

wait to see.

Maybe I reacted too hard in this regard.I for myself are happy, that this

methode was develloped, because they even start to treat people, who had a lap

myotomy before, which didn´t work. Mine is luckyly still working  3 years post

M)!You are absolutely right: Time will tell.

a

[Guest guest]

bdaddywags1 wrote:

>

>

> the hole self seals and is also closed by 5 clips. the esophagus is

> flushed with antibiotic before the procedure and you are on IV

> antibiotic and oral for 5 days after for precaution. To address you

> concern regarding infection.

>

Unfortunately, as we all know, antibiotics do not always work as well as

expected. I still have my concern.

notan