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Related Concept Videos

Endoscopic Procedures I: Esophagogastroduodenoscopy01:29

Endoscopic Procedures I: Esophagogastroduodenoscopy

69
An Esophagogastroduodenoscopy (EGD) is a diagnostic procedure in which an endoscopist uses a flexible, lighted endoscope to visualize the upper gastrointestinal (GI) tract. The procedure includes visualizing the oropharynx, esophagus, stomach, and the first part of the small intestine, the duodenum.
During an EGD, the endoscope can be used to:
69
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy01:26

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Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
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Endoscopic Procedures V: ERCP01:26

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Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
Patient...
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Esophageal Perforation-I: Introduction01:22

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Esophageal perforation is a severe medical condition characterized by a breach in the integrity of the esophageal wall. This breach can occur due to various factors such as trauma, medical procedures, or underlying diseases. When the esophageal wall is compromised, it allows food, fluids, and digestive juices into the chest cavity or adjacent structures, leading to potential complications and health risks.
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
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Esophageal Strictures-I: Introduction01:30

Esophageal Strictures-I: Introduction

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Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).
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The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
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Related Experiment Video

Updated: Jun 7, 2025

Use of the Scissor-Type Knife During the Peroral Endoscopy Myotomy Procedure for the Treatment of Achalasia
06:42

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Repeat peroral endoscopic myotomy: technical difficulty and risk factors.

Li-Yun Ma1, Ke-Yi Guo1, Zu-Qiang Liu1

  • 1Endoscopy Center and Endoscopy Research Institute, Shanghai Collaborative Innovation Center of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China.

Gastrointestinal Endoscopy
|November 18, 2024
PubMed
Summary

Repeat peroral endoscopic myotomy (Re-POEM) is a safe and feasible salvage therapy for achalasia after initial peroral endoscopic myotomy (POEM). Re-POEM shows comparable outcomes to naïve POEM, with specific factors predicting procedural difficulty.

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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery
  • Digestive Disease Management

Background:

  • Persistent or recurrent achalasia symptoms after peroral endoscopic myotomy (POEM) necessitate salvage treatment.
  • Repeat POEM (Re-POEM) is a potential option but may present increased technical challenges.

Purpose of the Study:

  • To evaluate the safety and technical difficulty of Re-POEM.
  • To compare Re-POEM outcomes with initial (naïve) POEM.

Main Methods:

  • Retrospective analysis of 158 patients undergoing Re-POEM and 2978 patients undergoing naïve POEM (July 2012-October 2023).
  • Propensity score matching (PSM) to create comparable groups.
  • Comparison of procedure-related parameters, including procedure time, myotomy length, and adverse events (AEs).
  • Multivariable analysis to identify risk factors for difficult Re-POEM (procedure time ≥90 minutes).

Main Results:

  • After PSM, procedure times were comparable between Re-POEM and naïve POEM groups (61.4 ± 27.0 vs 59.3 ± 29.9 minutes).
  • Re-POEM involved shorter esophageal myotomy but longer gastric myotomy lengths.
  • Mucosal injury, gas-related AEs, major AEs, and technical difficulty were similar between groups.
  • Mucosal edema and submucosal fibrosis were identified as independent risk factors for difficult Re-POEM.

Conclusions:

  • Re-POEM is a safe and feasible salvage therapy for patients with failed initial POEM.
  • Technical difficulty and adverse event rates are comparable to naïve POEM.
  • Mucosal edema and submucosal fibrosis predict challenges in Re-POEM procedures.