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Surg Endosc. 2016 Nov;30(11):5126-5133. Epub 2016 Apr 8.

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

Author information

1
Gastroenterology, New York Presbyterian Hospital - Weill Cornell, New York City, NY, USA.
2
Gastroenterology, Methodist Hospital, Dallas, TX, USA.
3
Gastroenterology, Temple University, Philadelphia, PA, USA.
4
Gastroenterology, Juarez Hospital, Mexico City, Mexico.
5
Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy.
6
Gastroenterology, Bogota General Hospital, Bogotá, Colombia.
7
Digestive and Liver Disease, New York Presbyterian - Columbia University Medical Center, New York City, NY, USA.
8
Gastroenterology, New York Presbyterian Hospital - Weill Cornell, New York City, NY, USA. mkahaleh@gmail.com.

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.

KEYWORDS:

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

PMID:
27059973
DOI:
10.1007/s00464-016-4859-0
[Indexed for MEDLINE]

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