Post written by Akiko Toshimori, MD, from the Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University Tokyo, Japan.

Last year, we reported POEM+fundoplication (POEM+F). In brief, POEM+F is a combination procedure of endoscopic myotomy and NOTES fundoplication for the purpose of preventing GERD after POEM. This time, we performed NOTES fundoplication for a PPI-refractory GERD patient, not for prevention but as a treatment. We named this procedure “POEF” as an offshoot of POEM.

We performed POEF on a patient who suffered refractory GERD after POEM. The treatment was effective, and the patient was able to stop PPI intake after POEF. We present the details of the procedure and his clinical course in the article and the video. This is the first case that achieved pure NOTES fundoplication for a PPI-refractory GERD patient.

One of the key points of this procedure is the safety of NOTES.  The mucosal flap safety valve (SEMF) technique reported by Dr Sumiyama and colleagues in 2007 enables us to do POEF safely. The most important point is reliability of the closure of the entry site.

For this procedure, we acquired several “pearls” from past great achievements. POEF, POEM, and POEM+F are based on an ESD technique, and the theory of NOTES was based on an SEMF technique. In addition, the safety and reliability of these procedures are maintained thanks to the double-scope method. Furthermore, this time, we applied the endoscopic hand suturing technique, originally developed by Dr Goto and colleagues for the closure of a post-ESD ulcer in 2014. An innovation brings us the next innovation.

Read the full article online.

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