title: Per-Oral Endoscopic Myotomy (POEM) After Previous Laparoscopic Heller Myotomy Is Feasible and Safe in a Porcine Model.
abstract: OBJECTIVE
  We sought to evaluate the feasibility, safety, and difficulty of performing the per-oral endoscopic myotomy (POEM) procedure in the setting of a prior Heller myotomy using a survival porcine model.
  
  
  METHODS
  Four pigs underwent laparoscopic Heller myotomy with Dor partial anterior fundoplication followed by the POEM performed 4 weeks later. Two additional pigs served as controls, undergoing only the POEM.
  
  
  RESULTS
  All procedures were completed without complications. The revisional POEM was not significantly more difficult than POEM controls based on procedure time, POEM procedure components, or procedure difficulty scores. Revisional POEM had a longer mean operative time when compared with Heller myotomy (126.0 vs. 83.8 min; P<0.01) but had a lower total difficulty score (28.6 vs. 52.1; P≪0.01).
  
  
  CONCLUSIONS
  A POEM after previous Heller myotomy is safe and feasible in the porcine model and has potential as an option for patients suffering from recurrent or persistent symptoms after failed surgical myotomy.
authors.affiliation: *Department of Surgery, Division of General Surgery †Department of Medicine, Division of Gastroenterology and Hepatology ‡Biomedical Resource Center, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Luke F
authors.initials: LF
authors.lastname: Miles
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Frelich
authors.forename: Jon C
authors.initials: JC
authors.lastname: Gould
authors.forename: Kulwinder S
authors.initials: KS
authors.lastname: Dua
authors.forename: Eric S
authors.initials: ES
authors.lastname: Jensen
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Kastenmeier
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D018662:Fundoplication / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011446:Prospective Studies; D012086:Reoperation; D013552:Swine