Peroral endoscopic myotomy and fundoplication: a novel NOTES procedure

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Endoscopic Procedures

Background:

• Peroral endoscopic myotomy (POEM) is a standard minimally invasive treatment for achalasia.
• Gastroesophageal reflux (GER) is a known complication following POEM.
• A modified POEM procedure incorporating fundoplication (POEM+F) was developed to address GER.

Purpose of the Study:

• To describe the technical aspects of the POEM+F procedure.
• To evaluate the short-term safety and feasibility of POEM+F.
• To assess the potential of POEM+F in mitigating post-POEM GER.

Main Methods:

• POEM+F was performed in 21 patients.
• A partial fundoplication was created using endoclips and an endoloop after myotomy.
• The endoscope was advanced into the peritoneal cavity to create the fundoplication.

Main Results:

• POEM+F was technically feasible in all patients.
• A visually recognizable fundoplication was successfully created.
• No immediate or delayed complications were observed post-procedure.

Conclusions:

• POEM+F is a safe and technically feasible endoscopic procedure.
• This technique may reduce the incidence of GER after POEM for achalasia.
• POEM+F represents a minimally invasive endoscopic alternative to surgical interventions.