title: Optical coherence tomography (OCT) prior to peroral endoscopic myotomy (POEM) reduces procedural time and bleeding: a multicenter international collaborative study.
abstract: Per-oral endoscopic myotomy (POEM) has emerged as an endoscopic treatment of achalasia. There are no pre-procedural imaging modalities to predict the safest and the most efficacious approach.
  
  
  
  To evaluate the use of optimal coherence tomography (OCT) in providing a pre-procedural esophageal assessment.
  
  
  
  Patients undergoing POEM from July 2013 to November 2015 were captured in a multicenter, international registry. Patients who underwent OCT pre-POEM ("OCT arm") were compared to patients without pre-POEM OCT ("control arm"). OCT images were assessed for the degree of vascularity and the thickness of the circular muscular layer, and an approach was determined.
  
  
  
  A total of 84 patients were captured in the registry. Fifty-one patients underwent pre-POEM OCT. Using OCT as a guide, 24 (47 %) of patients underwent anterior POEM while 27 (53 %) underwent posterior POEM. Technical success was achieved in 96 % of patients. Significantly less bleeding occurred in the OCT arm when compared to the control group [4 (8 %) vs. 14 (43 %), p = 0.0001]. As a result, procedural time was significantly lower in the OCT group as compared to the control group (85.8 vs. 121.7 min, p = 0.000097).
  
  
  
  Pre-POEM OCT results in a reduction in procedural bleeding which contributes to a reduction in overall procedural time.
  
  
  
  NCT01438385.
authors.affiliation: Gastroenterology, New York Presbyterian Hospital - Weill Cornell, New York City, NY, USA.
authors.forename: Amit P
authors.initials: AP
authors.lastname: Desai
authors.affiliation: Gastroenterology, New York Presbyterian Hospital - Weill Cornell, New York City, NY, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Tyberg
authors.affiliation: Gastroenterology, Methodist Hospital, Dallas, TX, USA.
authors.forename: Prashant
authors.initials: P
authors.lastname: Kedia
authors.affiliation: Gastroenterology, Temple University, Philadelphia, PA, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Smith
authors.affiliation: Gastroenterology, Juarez Hospital, Mexico City, Mexico.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Martinez
authors.affiliation: Gastroenterology, Juarez Hospital, Mexico City, Mexico.
authors.forename: Felipe
authors.initials: F
authors.lastname: Zamarripa
authors.affiliation: Gastroenterology, New York Presbyterian Hospital - Weill Cornell, New York City, NY, USA.
authors.forename: Yecheskel
authors.initials: Y
authors.lastname: Schneider
authors.affiliation: Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy.
authors.forename: Helga
authors.initials: H
authors.lastname: Bertani
authors.affiliation: Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy.
authors.forename: Marzio
authors.initials: M
authors.lastname: Frazzoni
authors.affiliation: Gastroenterology, Bogota General Hospital, Bogotá, Colombia.
authors.forename: Fernando
authors.initials: F
authors.lastname: Casas
authors.affiliation: Digestive and Liver Disease, New York Presbyterian - Columbia University Medical Center, New York City, NY, USA.
authors.forename: Lauren G
authors.initials: LG
authors.lastname: Khanna
authors.affiliation: Gastroenterology, New York Presbyterian Hospital - Weill Cornell, New York City, NY, USA.
authors.forename: Arnon
authors.initials: A
authors.lastname: Lambroza
authors.affiliation: Gastroenterology, New York Presbyterian Hospital - Weill Cornell, New York City, NY, USA.
authors.forename: Nikhil A
authors.initials: NA
authors.lastname: Kumta
authors.affiliation: Digestive and Liver Disease, New York Presbyterian - Columbia University Medical Center, New York City, NY, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Khan
authors.affiliation: Gastroenterology, New York Presbyterian Hospital - Weill Cornell, New York City, NY, USA.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.affiliation: Gastroenterology, New York Presbyterian Hospital - Weill Cornell, New York City, NY, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Salgado
authors.affiliation: Gastroenterology, New York Presbyterian Hospital - Weill Cornell, New York City, NY, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.affiliation: Digestive and Liver Disease, New York Presbyterian - Columbia University Medical Center, New York City, NY, USA.
authors.forename: Amrita
authors.initials: A
authors.lastname: Sethi
authors.affiliation: Gastroenterology, New York Presbyterian Hospital - Weill Cornell, New York City, NY, USA. mkahaleh@gmail.com.
authors.forename: Michel
authors.identifier: 0000-0003-0836-6114
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D016063:Blood Loss, Surgical; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging* / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D061646:Operative Time; D011300:Preoperative Care; D012042:Registries; D041623:Tomography, Optical Coherence
keywords: Achalasia; Endoflip; Lower esophageal sphincter; OCT; Optical coherence tomography; Peroral endoscopic myotomy