Surgeons normally work from the outside in and physicians from the inside out, but a pioneer of per-oral endoscopic myotomy (POEM) told delegates at Australian Gastroenterology Week that it was time to work together.
Presenting the annual Bushell lecture on the fusion of gastrointestinal endoscopy and surgery, Professor Haruhiro Inoue said the gap between the two approaches was narrowing.
Professor Inoue, director of the Digestive Diseases Center at Showa University Koto-Toyosu Hospital in Japan, was the first surgeon to perform a POEM in 2008 as a minimally invasive treatment for oesophageal achalasia.
He said that in the same way cardiac bypass was being replaced by stents, and aneurysms could be managed by coil embolisation instead of clipping, the laparoscopic Heller myotomy had been replaced by POEM.
“Surgery is 20th century; endoscopy is for the 21st century,” he said.
Professor Inoue said his group had now performed almost 1,500 POEMs in patients from 3 to 89 years of age and with all categories of achalasia.
He said there were fortunately no major complications and the success rate based on improvements in symptom scores was at least 95%.
Other centres were reporting similar success rates, he said.
“Patients with achalasia and related motility disorders can come into hospital and go straight for POEM or they could have the procedure after other strategies such as Botox injections or balloon dilatations have failed.”
He joked his first POEM patient had put on 20 kg and was 100% satisfied with the procedure.
Professor Inoue said the next development in 2013 had been gastric per-oral endoscopic myotomy (G-POEM) to treat patients with gastroparesis. The success rate was about 86%.
POEM was now also being applied to the resection of submucosal tumours in the form of per-oral endoscopic tumour resection (POET).
He told the limbic he was not yet ready to reveal the next version of the procedure.
Professor Inoue said the techniques should be reserved for specialised, high volume centres to maintain high technical standards however there were few barriers to entry for experienced endoscopists.
“Any procedure is the same. Watching and observing many good procedures is the first step.”
He said his institute was open for any overseas doctors who wanted to obtain temporary clinical licenses and perform at least 20 cases