John Keech

Peroral endoscopic myotomy (POEM) is a novel procedure for the treatment of achalasia and spastic esophageal disorders. Experience with POEM is limited, but its reported outcomes are excellent. It is deemed safe even for patients with prior interventions. This retrospective review included patients who underwent POEM at a tertiary US center. POEM was performed in a multidisciplinary approach by advanced endoscopists and foregut surgeons. Clinical success was defined as a post-POEM Eckardt score ≤3. A total of 125 patients were included. Median follow-up period was 18 months (interquartile range, 10-22 months). Clinical success was achieved in 92% of patients and persisted at 12 months in 88% of patients. Mucosal barrier failure (MBF) occurred in 7 patients, 2 of whom required surgical intervention. MBF was more common in patients with prior laparoscopic Heller myotomy (19% vs. 3%, p=0.015). MBF requiring surgical intervention occurred early in the learning curve. POEM is safe and effective in the treatment of achalasia and spastic esophageal disorders even after failed prior interventions.

Simon Roh, M.D., Mark D. Iannettoni, M.D., John Keech, M.D., Evgeny V. Arshava, M.D., Anthony Swatek, M.D., Miriam B. Zimmerman, Ph.D., Ronald J. Weigel, M.D., Ph.D., Kalpaj R. Parekh, M.B.B.S.. Korean J Thorac Cardiovasc Surg 2019;52:1-8. https://doi.org/10.5090/kjtcs.2019.52.1.1

Background: The tolerability of adjuvant chemotherapy in esophageal cancer is unclear. Patients and Methods: This was a phase II trial of adjuvant paclitaxel in patients with esophageal cancer after trimodality treatment. Patients with residual viable tumor after resection were eligible for study inclusion. Treatment was 80 mg/m(2) paclitaxel intravenously on days 1, 8, and 15 every 28 days for total of two cycles. The primary objective was to determine whether 75% or more of the patients would tolerate 240 mg/m(2) or more of paclitaxel, which corresponded to 50% or more of the total planned dose. Results: Eleven out of the 12 enrolled patients (92%, 95% confidence interval (CI)=62-100%) were able to complete at least 50% of the planned paclitaxel dose. Median progression free survival was 7 months (95% CI=2-28 months). Median overall survival was 28 months (95% CI=12-36 months). Only one patient experienced a grade 4 adverse event. Conclusion: Screening patients with esophageal cancer after trimodality treatment might improve completion of adjuvant trials.

Per oral endoscopic myotomy (POEM) has gained increasing popularity for treating achalasia. A multidisciplinary approach may allow safe and early adoption of POEM into clinical practice.

Response to “VATS vs. thoracotomy regarding postoperative chronic pain”

Response to “Editorial on pain following thoracic surgery”