The International Per Oral Endoscopic Myotomy Survey (IPOEMS): a snapshot of the global POEM experience
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and Other Interventional Techniques
The International Per Oral Endoscopic Myotomy Survey (IPOEMS): a snapshot of the global POEM experience Stavros N. Stavropoulos • Rani J. Modayil David Friedel • Thomas Savides
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Received: 18 January 2013 / Accepted: 4 March 2013 / Published online: 3 April 2013 Ó Springer Science+Business Media New York 2013
Abstract Background Per oral endoscopic myotomy (POEM) represents a Natural Orifice Transluminal Endoscopic Surgery (NOTES) approach to Heller myotomy. Even though we are now entering an exponential phase of growth with a large number of centers interested in POEM, published data to guide them are limited. As part of the July 2012 NOSCAR meeting, a conference was organized to review POEM and develop a consensus document. Authors SNS and TS who chaired the NOSCAR panel recognized the dearth of published data, which also may lag the rapid developments in POEM. Therefore, they undertook a survey of early POEM adopters around the world to rapidly obtain global, extensive, and current data on POEM. The raw survey data were made available to NOSCAR panel participants to assist with their presentations. We summarize the salient findings of the survey. Methods A comprehensive POEM survey was created and tested. The final survey instrument consisted of 197 questions that covered all aspects of POEM, including operator discipline, prior training, patient selection, setting, technique preference, results, adverse events, regulatory requirements, and perspectives on the future. An automated online response collector was used. S. N. Stavropoulos (&) R. J. Modayil D. Friedel Division of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, 222 Station Plaza North, Suite 429, Mineola, NY 11501, USA e-mail: [email protected] R. J. Modayil e-mail: [email protected] T. Savides Division of Gastroenterology, University of California San Diego Medial Center, San Diego, CA, USA
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Results The International Per Oral Endoscopic Myotomy Survey (IPOEMS) involved 16 expert centers, 7 in North America, 5 in Asia, 4 in Europe, including all high-volume centers (C30 POEMs per center), as of July 2012. These centers had performed 841 POEMs. There were modest variations among centers in technique and periprocedural management, but all centers uniformly reported excellent efficacy and safety outcomes. Conclusions The international POEM survey provides a ‘‘global snapshot’’ of the experience of early adopters. The excellent outcomes over a large cumulative volume of procedures are in line with those of published small series and lend further support to the notion that POEM represents a paradigm shift in the treatment of achalasia. Keywords Achalasia Per oral endoscopic myotomy (POEM) Natural orifice transluminal endoscopic surgery (NOTES) Heller myotomy
Current sources of evidence concerning per oral endoscopic myotomy (POEM) are relatively limited and rationale for this procedure is largely extrapolated from prior literature on laparoscopic Heller myotomy (LH
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