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Peroral endoscopic myotomy: 10-year outcomes from a large, single-center U.S. series with high follow-up completion and comprehensive analysis of long-term efficacy, safety, objective GERD, and endoscopic functional luminal assessment

Modayil, Rani J; Zhang, Xiaocen; Rothberg, Brooke; Kollarus, Maria; Galibov, Iosif; Peller, Hallie; Taylor, Sharon; Brathwaite, Collin E; Halwan, Bhawna; Grendell, James H; Stavropoulos, Stavros N
BACKGROUND AND AIMS/OBJECTIVE:Peroral endoscopic myotomy (POEM) is becoming the treatment of choice for achalasia. Data beyond 3 years are emerging but limited. We herein report our 10-year experience, focusing on long-term efficacy and safety including the prevalence, management, and sequelae of postoperative reflux. METHODS:This was a single-center prospective cohort study. RESULTS:Six hundred ten consecutive patients received POEM from October 2009 to October 2019 for type I achalasia in 160 (26.2%), II in 307 (50.3%), III in 93 (15.6%), untyped achalasia in 25 (4.1%), and nonachalasia disorders in 23 (3.8%). Two hundred ninety-two (47.9%) patients had prior treatment(s). There was no aborted POEM. Median operation time was 54 minutes. Accidental mucosotomies occurred in 64 (10.5%) and clinically significant adverse events (csAEs) in 21 (3.4%) patients. There were no adverse events (AEs) leading to death, surgery, interventional radiology interventions/drains, or altered functional status. At a median follow-up of 30 months, 29 failures occurred, defined as postoperative Eckardt score >3 or need for additional treatment. The Kaplan-Meier clinical success estimates at year 1, 2, 3, 4, 5, 6, and 7 were 98%, 96%, 96%, 94%, 92%, 91%, and 91%, respectively. These are highly accurate estimates because only 13 (2%) patients were missing follow-up assessments. One hundred twenty-five (20.5%) patients had reflux symptoms more than once per week. At a median of 4 months, the pH study was completed in 406 (66.6%) patients and was positive in 232 (57.1%) and endoscopy in 438 (71.8%) patients and showed reflux esophagitis in 218 (49.8%), mostly mild. CONCLUSION/CONCLUSIONS:POEM is exceptionally safe and highly effective on long-term follow-up, with >90% clinical success at ≥5 years.
PMID: 33989646
ISSN: 1097-6779
CID: 4867862

Incidental finding of inflammatory fibroid polyp of the appendix in a patient with acute appendicitis

Sy, Alexander M; Vo, Duc; Friedel, David; Grendell, James; Hanna, Iman
PMCID:7759229
PMID: 33361049
ISSN: 2148-5607
CID: 4770942

Learning Curve for Endoscopic Submucosal Dissection With an Untutored, Prevalence-Based Approach in the United States

Zhang, Xiaocen; Ly, Erin K; Nithyanand, Sagarika; Modayil, Rani J; Khodorskiy, Dmitriy O; Neppala, Sivaram; Bhumi, Sriya; DeMaria, Matthew; Widmer, Jessica L; Friedel, David M; Grendell, James H; Stavropoulos, Stavros N
BACKGROUND & AIMS/OBJECTIVE:Endoscopic submucosal dissection (ESD) is widely used in Asia to resect early-stage gastrointestinal neoplasms, but use of ESD in Western countries is limited. We collected data on the learning curve for ESD at a high-volume referral center in the United States to guide development of training programs in the Americas and Europe. METHODS:/hr. RESULTS:/hr in esophagus, stomach, and colon, respectively. CONCLUSIONS:In an analysis of ESDs performed at a large referral center in the United States, we found that an untutored, prevalence-based approach allowed operators to achieve all proficiency benchmarks after ∼250 cases. Compared with Asia, ESD requires more time to learn in the West, where the untutored, prevalence-based approach requires resection of challenging lesions, such as colon lesions and previously manipulated lesions, in early stages of training.
PMID: 31220645
ISSN: 1542-7714
CID: 3954512

PER ORAL ENDOSCOPIC MYOTOMY (POEM): 10-YEAR OUTCOME FROM A LARGE US REFERRAL CENTER [Meeting Abstract]

Modayil, Rani J.; Zhang, Xiaocen; Rothberg, Brooke; Peller, Hallie; Brathwaite, Collin E.; Kollarus, Maria; Taylor, Sharon; Grendell, James H.; Stavropoulos, Stavros N.
ISI:000545678400246
ISSN: 0016-5107
CID: 4790362

Impact of Institutional Enteral Feeding Tube Policy on Medical Nutrition Utilization [Meeting Abstract]

Gindi, Derek; He, Harry; Patil, Sagar; Ballecer, Eric; Pinto, Priya; Grendell, James; Berger, Jeffrey; Islam, Shahidul
ISI:000607196703187
ISSN: 0002-9270
CID: 4790402

EFTR AND STER FOR GASTROINTESTINAL SUBEPITHELIAL TUMORS (SETS): LARGE SERIES FROM A LARGE US REFERRAL CENTER [Meeting Abstract]

Stavropoulos, Stavros N.; Modayil, Rani J.; Zhang, Xiaocen; Peller, Hallie; Brathwaite, Collin E.; Allendorf, John; Widmer, Jessica L.; Friedel, David; Grendell, James H.
ISI:000545678400464
ISSN: 0016-5107
CID: 4790372

Association of Antibiotic and Proton Pump Inhibitor Usage in Patients with Hospital Acquired Clostridium difficile Infection: A Single Center Experience [Meeting Abstract]

Ballecer, Eric; Ali, Mohammad; Patel, Zinal; Shen, Mark; Islam, Shahidul; Vrabie, Raluca; Grendell, James H.
ISI:000464611002222
ISSN: 0002-9270
CID: 3897692

A Rare Case of High-Grade Dysplasia in Sporadic Fundic Gland Polyps [Meeting Abstract]

Ballecer, Eric; Muddasani, Ramya; Forman, Jacqueline; Shah, Rakesh; Ram, Bebu; Arendash, Barbara; Grendell, James H.
ISI:000464611005179
ISSN: 0002-9270
CID: 3897742

Mesenteric Venous Thrombosis Presenting as Subacute Diarrhea: A Rare but Tragic Case [Meeting Abstract]

DeMaria, Matthew J.; Vedula, Jogarao; Ahmed, Haseeb; Grendell, James H.
ISI:000464611005036
ISSN: 0002-9270
CID: 3897732

NOTES FOR SUBEPITHELIAL TUMORS: EFTR AND STER A SINGLE CENTER FIVE YEAR PROSPECTIVE SERIES IN THE US [Meeting Abstract]

Stavropoulos, Stavros N.; Modayil, Rani J.; Zhang, Xiaocen; Khodorskiy, Dmitriy O.; Ly, Erin K.; Neppala, Sivaram; Peller, Hallie; Widmer, Jessica L.; Brathwaite, Collin E.; Grendell, James H.
ISI:000434248200457
ISSN: 0016-5107
CID: 3514232