PMID- 34466356
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210903
IS  - 2364-3722 (Print)
IS  - 2196-9736 (Electronic)
IS  - 2196-9736 (Linking)
VI  - 9
IP  - 9
DP  - 2021 Sep
TI  - Double tunnel technique reduces technical failure during POEM in cases with 
      severe submucosal fibrosis.
PG  - E1335-E1341
LID - 10.1055/a-1499-6817 [doi]
AB  - Background and study aims  Submucosal fibrosis (SMF) is one of the major reasons 
      for technical failure during per-oral endoscopic myotomy (POEM). In this study, 
      we aimed to evaluate the impact of double tunnel technique (DT-POEM) on the 
      technical success of POEM in cases with severe SMF. Patients and methods  Data 
      from patients with achalasia in whom SMF was encountered during POEM from Jan 
      2013 to Jan 2020 at our center were retrospectively evaluated. The technical 
      success and adverse events (AEs) were analyzed and compared between cases with 
      SMF who underwent POEM via single tunnel versus DT-POEM technique. Results  A 
      total of 1,150 patients underwent POEM during the study period. There were 14 
      technical failures (1.2 %). SMF and severe SMF was found in 104 (9 %) and 21 
      (1.8 %) patients, respectively. The majority of patients (17, 80.9 %) with severe 
      SMF had type I achalasia. Overall, technical failures occurred in 14 cases 
      (1.2 %) and severe SMF resulted in the majority of the technical failures (10, 
      71.4 %). DT-POEM was utilized in 11 cases (52.4 %) with severe SMF. The median 
      procedure time with DT-POEM was 150 minutes (85-210). There were no major AEs and 
      DT-POEM was technically successful in all the patients. The technical success of 
      POEM in cases with SMF improved after the adoption of the double tunnel technique 
      (98.4 % vs 68.3 %, P  = 0.0001). Conclusions  Severe SMF is the most common 
      reason for technical failure during POEM. DT-POEM improves the technical success 
      rates of POEM in patients with severe SMF.
CI  - The Author(s). This is an open access article published by Thieme under the terms 
      of the Creative Commons Attribution-NonDerivative-NonCommercial License, 
      permitting copying and reproduction so long as the original work is given 
      appropriate credit. Contents may not be used for commercial purposes, or adapted, 
      remixed, transformed or built upon. 
      (https://creativecommons.org/licenses/by-nc-nd/4.0/).
FAU - Nabi, Zaheer
AU  - Nabi Z
AD  - Asian institute of Gastroenterology, Hyderabad, India.
FAU - Ramchandani, Mohan
AU  - Ramchandani M
AD  - Asian institute of Gastroenterology, Hyderabad, India.
FAU - Chavan, Radhika
AU  - Chavan R
AD  - Asian institute of Gastroenterology, Hyderabad, India.
FAU - Basha, Jahangeer
AU  - Basha J
AD  - Asian institute of Gastroenterology, Hyderabad, India.
FAU - Reddy, Manohar
AU  - Reddy M
AD  - Asian institute of Gastroenterology, Hyderabad, India.
FAU - Darisetty, Santosh
AU  - Darisetty S
AD  - Asian institute of Gastroenterology, Hyderabad, India.
FAU - Reddy, Nageshwar D
AU  - Reddy ND
AD  - Asian institute of Gastroenterology, Hyderabad, India.
LA  - eng
PT  - Journal Article
DEP - 20210816
PL  - Germany
TA  - Endosc Int Open
JT  - Endoscopy international open
JID - 101639919
PMC - PMC8367433
COIS- Competing interest The authors declare that they have no conflict of interest.
EDAT- 2021/09/02 06:00
MHDA- 2021/09/02 06:01
PMCR- 2021/08/01
CRDT- 2021/09/01 07:24
PHST- 2020/12/20 00:00 [received]
PHST- 2021/03/02 00:00 [accepted]
PHST- 2021/09/01 07:24 [entrez]
PHST- 2021/09/02 06:00 [pubmed]
PHST- 2021/09/02 06:01 [medline]
PHST- 2021/08/01 00:00 [pmc-release]
AID - 10.1055/a-1499-6817 [doi]
PST - epublish
SO  - Endosc Int Open. 2021 Aug 16;9(9):E1335-E1341. doi: 10.1055/a-1499-6817. 
      eCollection 2021 Sep.