Endoscopic Myotomy(POEM)

[Guest guest]

Has anyone had this clinical trial procedure. Winthrop in NY has done 24 so far?

Looking for comments on results/symptom relief from the procedure over the past

2 years.

[Guest guest]

No, I had an open-chest myotomy 20 years ago.  My gastroenterologist has

suggested this as an option now for some problems I have been having recently so

I am interested in people's experiences as well.  In the meantime, I am having a

botox injection tomorrow morning!

[Guest guest]

Hi - I was recently diagnosed with Achalasia in the NY area. I went through the

endoscopy, barium swallow, and mammotery and all confirmed the achalasia.

I have not had any treatments up until this point and I have been discussing my

options with as many people as possible. Right now I am strongly leaning

towards POEM surgery at either Winthrop or Case Western. I know there have not

been any long term studies done on POEM yet, but the short term results are very

promissing. To me, this surgery just makes more sense as the natural structure

of your esophagus gets to remain in tact. The fact that a reflux procedure is

also not needed is a huge benefit. It would not surprise me within 5 years that

all surgery for Achalasia is done via POEM.

That being said I am still doing my research and will be taking trips to

Winthrop and Case Western to speak with Dr. Starvopolus and Dr. Ponsky. The

risks are a bit more elevated with this procedure since it is so new, but I just

think the potential benefits are worth it vs HM.

Please share any experiences you have with POEM as I am highly interested.

Thanks,

Ben

>

> Has anyone had this clinical trial procedure. Winthrop in NY has done 24 so

far? Looking for comments on results/symptom relief from the procedure over the

past 2 years.

>

[Guest guest]

Hi Ben,

What I know about POEM is what my not very

communicative GI doc told me at Mayo last week.

Mayo has done 1 and Japan has done about

100. For me it is too experimental.

Good luck,

Faith

Sent from my iPod

On May 14, 2012, at 9:19, " bonedoggy323 " <Belliott323@...> wrote:

> Hi - I was recently diagnosed with Achalasia in the NY area. I went through

the endoscopy, barium swallow, and mammotery and all confirmed the achalasia.

>

> I have not had any treatments up until this point and I have been discussing

my options with as many people as possible. Right now I am strongly leaning

towards POEM surgery at either Winthrop or Case Western. I know there have not

been any long term studies done on POEM yet, but the short term results are very

promissing. To me, this surgery just makes more sense as the natural structure

of your esophagus gets to remain in tact. The fact that a reflux procedure is

also not needed is a huge benefit. It would not surprise me within 5 years that

all surgery for Achalasia is done via POEM.

>

> That being said I am still doing my research and will be taking trips to

Winthrop and Case Western to speak with Dr. Starvopolus and Dr. Ponsky. The

risks are a bit more elevated with this procedure since it is so new, but I just

think the potential benefits are worth it vs HM.

>

> Please share any experiences you have with POEM as I am highly interested.

>

> Thanks,

>

> Ben

>

>

> >

> > Has anyone had this clinical trial procedure. Winthrop in NY has done 24 so

far? Looking for comments on results/symptom relief from the procedure over the

past 2 years.

> >

>

>

[Guest guest]

Interesting: POEM, followed by a Heller four months later.

http://meetings.ssat.com/abstracts/2012/V13.cgi

> > >

> > > Has anyone had this clinical trial procedure. Winthrop in NY has done 24

so far? Looking for comments on results/symptom relief from the procedure over

the past 2 years.

> > >

> >

> >

>

>

>

[Guest guest]

I just went to my first appointment today at University of Chicago and met with

Dr Konda. She does all the dilations for Dr Marco Patti, who does all the

surgical myotomies. She said that since I already had a pnuematic dilation I was

not a candidate for POEM. Maybe other hospitals are different but that is what

she told me!

________________________________

From: bonedoggy323 <Belliott323@...>

achalasia

Sent: Monday, May 14, 2012 8:19 AM

Subject: Re: Endoscopic Myotomy(POEM)

 

Hi - I was recently diagnosed with Achalasia in the NY area. I went through the

endoscopy, barium swallow, and mammotery and all confirmed the achalasia.

I have not had any treatments up until this point and I have been discussing my

options with as many people as possible. Right now I am strongly leaning

towards POEM surgery at either Winthrop or Case Western. I know there have not

been any long term studies done on POEM yet, but the short term results are very

promissing. To me, this surgery just makes more sense as the natural structure

of your esophagus gets to remain in tact. The fact that a reflux procedure is

also not needed is a huge benefit. It would not surprise me within 5 years that

all surgery for Achalasia is done via POEM.

That being said I am still doing my research and will be taking trips to

Winthrop and Case Western to speak with Dr. Starvopolus and Dr. Ponsky. The

risks are a bit more elevated with this procedure since it is so new, but I just

think the potential benefits are worth it vs HM.

Please share any experiences you have with POEM as I am highly interested.

Thanks,

Ben

>

> Has anyone had this clinical trial procedure. Winthrop in NY has done 24 so

far? Looking for comments on results/symptom relief from the procedure over the

past 2 years.

>

[Guest guest]

I've had a pneumatic and HM 21 years ago.

I wasn't told I couldn't be a candidate. It is quite

new and I suspect they are being cautious.

Sent from my iPod

On May 14, 2012, at 21:00, Kim Abrams <xploring37@...> wrote:

> I just went to my first appointment today at University of Chicago and met

with Dr Konda. She does all the dilations for Dr Marco Patti, who does all the

surgical myotomies. She said that since I already had a pnuematic dilation I was

not a candidate for POEM. Maybe other hospitals are different but that is what

she told me!

>

> ________________________________

> From: bonedoggy323 <Belliott323@...>

> achalasia

> Sent: Monday, May 14, 2012 8:19 AM

> Subject: Re: Endoscopic Myotomy(POEM)

>

>

>

>

> Hi - I was recently diagnosed with Achalasia in the NY area. I went through

the endoscopy, barium swallow, and mammotery and all confirmed the achalasia.

>

> I have not had any treatments up until this point and I have been discussing

my options with as many people as possible. Right now I am strongly leaning

towards POEM surgery at either Winthrop or Case Western. I know there have not

been any long term studies done on POEM yet, but the short term results are very

promissing. To me, this surgery just makes more sense as the natural structure

of your esophagus gets to remain in tact. The fact that a reflux procedure is

also not needed is a huge benefit. It would not surprise me within 5 years that

all surgery for Achalasia is done via POEM.

>

> That being said I am still doing my research and will be taking trips to

Winthrop and Case Western to speak with Dr. Starvopolus and Dr. Ponsky. The

risks are a bit more elevated with this procedure since it is so new, but I just

think the potential benefits are worth it vs HM.

>

> Please share any experiences you have with POEM as I am highly interested.

>

> Thanks,

>

> Ben

>

>

> >

> > Has anyone had this clinical trial procedure. Winthrop in NY has done 24 so

far? Looking for comments on results/symptom relief from the procedure over the

past 2 years.

> >

>

>

[Guest guest]

Faith wrote:

<I've had a pneumatic and HM 21 years ago.

<I wasn't told I couldn't be a candidate. It is quite

<new and I suspect they are being cautious.

<Sent from my iPod

<On May 14, 2012, at 21:00, Kim Abrams <xploring37@...> wrote:

> I just went to my first appointment today at University of Chicago and met

with Dr Konda. <She does all the dilations for Dr Marco Patti, who does all the

surgical myotomies. She <said that since I already had a pnuematic dilation I

was not a candidate for POEM. Maybe <other hospitals are different but that is

what she told me!

 

I think as well, that in the beginning, the physician, who does the

proceedure is more carefull and will choose first the " most optimal " patient.

I know from Hamburg University in Germany (UKE), that they have done POEM on

patients which had  several dilatations and do as well in patients wir markedly

distended Esophagus. It depends as well, they say, how the angulation from

esophagus to stomach is presented by a Ba-Swallow. They did already more than 50

cases in less than 2 years. Their reflux rate post proceedure is about 12%.

 

a

[Guest guest]

OMG!!!!  Besides all the A physical problems I'm so indecisive about what to

do!!!!!  I've got a dilation scheduled..first intervention.....should I wait to

find out more about POEM?????  I'm 49....and in general good health

otherwise.....Help.....all ideas/thoughts welcome!!!!!

 

________________________________

From: a Haas <dd.haas@...>

achalasia

Sent: Tue, May 15, 2012 6:08:53 AM

Subject: Re: Re: Endoscopic Myotomy(POEM)

 

Faith wrote:

<I've had a pneumatic and HM 21 years ago.

<I wasn't told I couldn't be a candidate. It is quite

<new and I suspect they are being cautious.

<Sent from my iPod

<On May 14, 2012, at 21:00, Kim Abrams <xploring37@...> wrote:

> I just went to my first appointment today at University of Chicago and met

with

>Dr Konda. <She does all the dilations for Dr Marco Patti, who does all the

>surgical myotomies. She <said that since I already had a pnuematic dilation I

>was not a candidate for POEM. Maybe <other hospitals are different but that is

>what she told me!

 

I think as well, that in the beginning, the physician, who does the

proceedure is more carefull and will choose first the " most optimal " patient.

I know from Hamburg University in Germany (UKE), that they have done POEM on

patients which had  several dilatations and do as well in patients wir markedly

distended Esophagus. It depends as well, they say, how the angulation from

esophagus to stomach is presented by a Ba-Swallow. They did already more than 50

cases in less than 2 years. Their reflux rate post proceedure is about 12%.

 

a

[Guest guest]

wrote:

<OMG!!!! Besides all the A physical problems I'm so indecisive about what to

<do!!!!! I've got a dilation scheduled..first intervention.....should I wait to

<find out more about POEM????? I'm 49....and in general good health

<otherwise.....Help.....all ideas/thoughts welcome!!!!!

 

Depends, how severe your swallowing situation is,wheather you can wait.

I opted for a myotomy, as the statitic figures are better in longterm. I´m 3

years post Myotomie and can eat nearly without restrictions. Sometimes I have to

drink some water to flush.

For having a myotomy you have 2 options, either the laparoscopic Myotomie(which

is well established) or the peroral Myotomie (POEM), which is fairly new, but

very promising.

 

a

 

[Guest guest]

I'm wondering if the POEM stats don't look so good *because* they've cherry

picked their patients? Certainly surgeons grumble about a Heller being more

difficult if you've had a dilation or two or three, but haven't heard of them

*refusing*. . . . Given the stats, I'm *really* surprised they would do

dilatations on *anyone* under sixty.

Perhaps some patients fear of surgery is so strong they feel have no choice?

Tis a puzzlement.

xox

> <OMG!!!! Besides all the A physical problems I'm so indecisive about what to

> <do!!!!! I've got a dilation scheduled..first intervention.....should I wait

to

> <find out more about POEM????? I'm 49....and in general good health

> <otherwise.....Help.....all ideas/thoughts welcome!!!!!

>  

> Depends, how severe your swallowing situation is,wheather you can wait.

> I opted for a myotomy, as the statitic figures are better in longterm. I´m 3

years post Myotomie and can eat nearly without restrictions. Sometimes I have to

drink some water to flush.

> For having a myotomy you have 2 options, either the laparoscopic

Myotomie(which is well established) or the peroral Myotomie (POEM), which is

fairly new, but very promising.

>  

> a

>  

>

>

[Guest guest]

What are the stats for HM vs dilitation for those under 60?

Sent from my iPod

On May 15, 2012, at 8:50, " puddleriver13 " <puddleriver13@...> wrote:

> I'm wondering if the POEM stats don't look so good *because* they've cherry

picked their patients? Certainly surgeons grumble about a Heller being more

difficult if you've had a dilation or two or three, but haven't heard of them

*refusing*. . . . Given the stats, I'm *really* surprised they would do

dilatations on *anyone* under sixty.

>

> Perhaps some patients fear of surgery is so strong they feel have no choice?

Tis a puzzlement.

>

> xox

>

>

> > <OMG!!!! Besides all the A physical problems I'm so indecisive about what to

> > <do!!!!! I've got a dilation scheduled..first intervention.....should I wait

to

> > <find out more about POEM????? I'm 49....and in general good health

> > <otherwise.....Help.....all ideas/thoughts welcome!!!!!

> >

> > Depends, how severe your swallowing situation is,wheather you can wait.

> > I opted for a myotomy, as the statitic figures are better in longterm. I´m

3 years post Myotomie and can eat nearly without restrictions. Sometimes I have

to drink some water to flush.

> > For having a myotomy you have 2 options, either the laparoscopic

Myotomie(which is well established) or the peroral Myotomie (POEM), which is

fairly new, but very promising.

> >

> > a

> >

> >

> >

[Guest guest]

" Pneumatic dilation is one of the most well-established procedures for achalasia

and is associated with a good initial response but only modest long-term

improvement. About 50% of patients require a second or even third dilation in

the first 5 years. There is a low but significant risk of perforation from this

procedure. "

" Predictors of Outcome

The two best predictors of outcome following PD appear to be postdilatation LES

pressure and age.34, 37, 39 In keeping with the surgical literature,

posttreatment LES pressures of 10 mmHg are associated with a better outcome;

patients who achieved a postdilation pressure of <10 mmHg were much more likely

to be in remission during follow-up compared to those with higher LES pressures

(100% versus 23%).37 Younger patients (<40 years of age) also appear to do less

well in response to pneumatic dilatation.37, 42, 43, 44 In the series discussed

above, for example, the remission rate in patients older than 40 was much higher

than in younger patients (67% versus 29%).37 "

http://www.nature.com/gimo/contents/pt1/full/gimo52.html

" The only therapies that adequately compensate for this dysfunction for a

sustained time are pneumatic dilation and Heller myotomy. The single controlled

trial comparing these treatments found surgery superior to dilation (95% vs 51%

nearly complete symptom resolution, P<.01) "

http://www.uptodate.com/contents/patient-information-achalasia-beyond-the-basics\

/abstract/1-7

" However, there was a greater need for redilation in patients younger than 40 in

the pneumatic-dilation group which the authors said may suggest that " younger

patients (especially men) should be treated preferentially with laparoscopic

myotomy. "

http://www.medpagetoday.com/Pulmonology/GeneralPulmonary/26467

https://docs.google.com/viewer?a=v & q=cache:htK5z0fLR-oJ:www.rima.org/web/medline\

_pdf/ClinGastroenterolHepatoL_580_7.pdf+ & hl=en & gl=us & pid=bl & srcid=ADGEESh4UFo6qZ\

TVz1RYIg5rVsrNQ1yscGUsYZtwoGoTfxLlq8zq13VWKZelwLPK7KC6HAWR8OY7gFAyY0AeLQhIKmHB6j\

Z1qYy2XmqYIZkX5FJSre3AG0i3mINN8P2au4S6irTDoSiC & sig=AHIEtbRNRzFh_A_ohiWN6zUffWndY\

m8vRw & pli=1

>

> What are the stats for HM vs dilitation for those under 60?

[Guest guest]

Considering it is a fairly new procedure, I would be cautious. A majority of the

people who have myotomies are very happy with the results!

________________________________

From: a Haas <dd.haas@...>

achalasia

Sent: Tuesday, May 15, 2012 5:50 AM

Subject: Re: Re: Endoscopic Myotomy(POEM)

 

wrote:

<OMG!!!! Besides all the A physical problems I'm so indecisive about what to

<do!!!!! I've got a dilation scheduled..first intervention.....should I wait to

<find out more about POEM????? I'm 49....and in general good health

<otherwise.....Help.....all ideas/thoughts welcome!!!!!

 

Depends, how severe your swallowing situation is,wheather you can wait.

I opted for a myotomy, as the statitic figures are better in longterm. I´m 3

years post Myotomie and can eat nearly without restrictions. Sometimes I have to

drink some water to flush.

For having a myotomy you have 2 options, either the laparoscopic Myotomie(which

is well established) or the peroral Myotomie (POEM), which is fairly new, but

very promising.

 

a

 

[Guest guest]

Kim wrote:

 

<Considering it is a fairly new procedure, I would be cautious. A majority of

the people who <have myotomies are very happy with the results!

 

POEM does the same as the lap. Myotomie, it cuts the muscle, at the

esophagogastric junction,- only the approach is different. In short term the

results are as good as the lap. myotomie and you don 't need the wrap. The other

thing, if you should need later a lap Myotomie, there is no scar tissue, that

complicates the proceeduce (see previous link from about a POEM Patient,

who had a lap redo because of a complication).

But everyone has to dicide for himself and I can understand, that some prefer

the established methode.

 

a

[Guest guest]

a wrote:

>

> POEM does the same as the lap. Myotomie, it cuts the muscle, at the

> esophagogastric junction,- only the approach is different.

>

There is more than the approach that is different. POEM doesn't cut

through both muscle layers. It tunnels along inside the circular muscle

layer. That has the potential to be a big plus but time is needed to

know for sure. In lap myotomies some surgeons prefer the toupet wrap

over the Dor because it holds the myotomy open helping to keep the

muscle layer from reconnecting. With POEM that uncut muscle layer will

prevent the cut layer from separating as much. One of the reason a

dilatation may not last as long as a myotomy is that the broken fibers

from a dilatation are more easily reconnected. On the other hand, some

surgeons prefer the Dor wrap because it protects the myotomy and

prevents the development of a pseudo diverticulum due to the weakened

area. The POEM may have less problems with pseudo diverticulum than even

a Dor and it does not use a wrap (but time will tell if it should). I

don't think the claims or concerns in these contexts, reattachment and

pseudo diverticulum, have been proven for either the toupet or POEM.

If you know of a long-term study that proves the quality of POEM in this

context let me know. Of course no one does. So far, early on, POEM looks

good.

New car models are alway tempting because they have the newest tech, but

older lines are tempting because they have the bugs worked out or you

know what they are. Generally the new models are great off the lot but

sometimes some time later some nasty bugs show up that will be prevented

in later versions. Surgery is like that too.

If POEM was the same as lap there wouldn't be any reason to have one

over the other. The reason POEM may be better than lap is because it is

not the same as lap but the difference is new tech. At the heart of it,

it is a one layer myotomy and not a two layer myotomy. That is

different. You could do that lap, a one layer myotomy using tunneling

and it would be different from the standard myotomy too even though the

approach would be the same. I would not be surprise if one day you see

surgeons that are concerned that POEM should have a wrap develop a lap

tunneling method so that they can add the wrap, if the tunneling

otherwise proves worth it (big if).

notan