# Achalasia — GCMD Library living collection

Everything in the library about achalasia — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 33 cited statements

## Episodes
### Surgical Management
- [Laparoscopic Heller Myotomy](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252) — video · 3:32 · [machine version](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252.md)

### Evidence & Research
- [Update Course Rewind: 2023 Top Ten Key Takeaways](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758) — video · 16:22 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758.md)

### In-Depth Reviews
- [Update Course 2023 - Updates in Pediatric Achalasia Management](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270) — video · 26:54 · [machine version](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270.md)

## Chapters
- [0:06](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=6) Introduction to Heller myotomy and procedural overview (Ep 1)
- [1:30](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=90) Case presentation and trocar placement (Ep 1)
- [2:10](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=130) Myotomy technique without energy (Ep 1)
- [3:00](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=180) Completion of myotomy, fundoplication, and outcome (Ep 1)
- [0:03](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=3) Introduction and Achalasia Classification (Ep 2)
- [5:10](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=310) Treatment Options and Fundoplication Debate (Ep 2)
- [11:14](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=674) Management of Recurrent Symptoms (Ep 2)
- [16:48](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1008) POEM Technique and Outcomes (Ep 2)
- [21:13](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1273) Dissemination and Training Challenges (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=0) Introduction and POEM Procedure for Achalasia (Ep 3)
- [1:52](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=112) Blunt Cerebrovascular Injury Screening (Ep 3)
- [3:12](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=192) Early Discharge After Pyloromyotomy (Ep 3)
- [4:36](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=276) ICG for Sentinel Node Identification (Ep 3)
- [6:21](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=381) Anal Dilations Following PSARP (Ep 3)
- [7:58](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=478) Fertility Preservation in Pediatric Oncology (Ep 3)
- [9:40](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=580) Massive Transfusion Protocol (Ep 3)
- [11:24](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=684) Ovarian Torsion Management (Ep 3)
- [12:54](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=774) Total Pancreatectomy with Islet Auto-Transplantation (Ep 3)
- [14:22](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=862) Blunt Hepatosplenic Trauma Management (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The gold standard for achalasia treatment is laparoscopic Heller myotomy." (host_summary) [Ep 3 · 0:38](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=38)
- "POEM (peroral endoscopic myotomy) provides 360 degrees of options to perform myotomy, whereas with Heller myotomy you have maybe 180 degrees and must worry about the vagus nerve." (clinical) [Ep 3 · 1:06](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=66)
- "POEM can be performed after a failed Heller or previous POEM by choosing a different side for dissection, avoiding burned bridges." (clinical) [Ep 3 · 1:22](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=82)
- "POEM does not require dissection of the hiatus, reducing concern for reflux." (clinical) [Ep 3 · 1:32](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=92)
- "Blunt cerebrovascular injury (BCVI) occurs in 1.3% of all head trauma in the pediatric population." (host_summary) [Ep 3 · 2:02](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=122)
- "Nearly one-third of pediatric patients with BCVI will have a stroke, increasing mortality up to 20%." (host_summary) [Ep 3 · 2:02](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=122)
- "A patient with delayed diagnosis stroke from a missed BCVI prompted the institution to create a routine BCVI screening protocol requiring CTA head and neck for at-risk patients." (clinical) [Ep 3 · 2:24](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=144)
- "The Memphis score is the most sensitive scoring system for BCVI screening in pediatric head trauma patients." (host_summary) [Ep 3 · 2:51](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=171)
- "Patients under 37 weeks gestational age require overnight monitoring following anesthesia after pyloromyotomy, even if tolerating feeds shortly after surgery." (host_summary) [Ep 3 · 3:45](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=225)
- "Full-term babies over 4 weeks old may be eligible for discharge from PACU after pyloromyotomy." (host_summary) [Ep 3 · 3:56](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=236)
- "NSQIP data shows only 1.5% of pyloromyotomy patients were discharged on day of surgery, with no difference in odds of readmission or complications compared to overnight stay." (host_summary) [Ep 3 · 4:01](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=241)
- "ICG (indocyanine green) has become increasingly integrated into biliary-related surgeries such as cholecystectomies due to its hepatic excretion." (host_summary) [Ep 3 · 4:46](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=286)
- "Technetium-99 requires a special machine to detect and is difficult to control the injection timing." (host_summary) [Ep 3 · 5:08](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=308)
- "ICG technique is real-time in the operating room with equipment that is standard or soon to be standard in all laparoscopic towers." (host_summary) [Ep 3 · 5:20](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=320)
- "With ICG injection into the tumor, you can watch over 45-75 seconds as the ICG travels to the sentinel node with lights off under fluorescence." (host_summary) [Ep 3 · 5:52](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=352)
- "Recent studies have revealed a lack of firm correlation between anal dilations and stricture development following PSARP." (host_summary) [Ep 3 · 6:39](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=399)
- "Many PSARP patients have a colostomy and will undergo another procedure for colostomy closure, which is a perfect moment to perform strictureplasty if needed." (host_summary) [Ep 3 · 7:02](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=422)
- "The surgeon sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses whether dilations are needed based on the examination, informing families that strictureplasty may be needed later." (host_summary) [Ep 3 · 7:13](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=433)
- "Every society emphasizes fertility preservation counseling even when surgery is not planned for children facing gonadotoxic therapy." (host_summary) [Ep 3 · 8:20](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=500)
- "When a patient has a new cancer diagnosis or is approaching stem cell transplant, the fertility preservation counseling service is activated through an Epic order set, triggering consultation by advanced practice nurse, physician, or oncology team for risk assessment." (host_summary) [Ep 3 · 8:36](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=516)
- "In a prepubertal child, the ovary is about 2 centimeters in size, approximately the size of a grape, and laparoscopic oophorectomy is the best recommendation for ovarian tissue preservation." (host_summary) [Ep 3 · 9:05](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=545)
- "Laparoscopic oophorectomy is recommended to reduce the risk of hemorrhage and ensure remaining ovarian tissue is preserved for future fertility." (host_summary) [Ep 3 · 9:17](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=557)
- "Massive transfusion protocol (MTP) is a multidisciplinary process for rapidly obtaining blood and blood products for severely bleeding patients." (host_summary) [Ep 3 · 9:49](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=589)
- "If you are giving blood in the trauma bay, you need to activate MTP—giving blood equals MTP activation." (guideline) [Ep 3 · 10:15](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=615)
- "For bad trauma with unstable or abnormal patients, whole blood would be the best option." (opinion) [Ep 3 · 10:39](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=639)
- "The blood bank has not been able to provide whole blood for pediatric patients because it needs to be irradiated." (clinical) [Ep 3 · 10:48](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=648)
- "The goal is 1:1:1 ratio of blood products (packed red blood cells:FFP:platelets), with FFP given after blood." (guideline) [Ep 3 · 10:53](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=653)
- "Most hospital trauma coolers do not initially contain platelets, requiring separate call for platelets through MTP or direct request." (clinical) [Ep 3 · 10:58](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=658)
- "Massive transfusion protocol should be activated after administering 20 mL/kg of blood in the trauma bay." (host_summary) [Ep 3 · 11:08](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=668)
- "Ovarian torsion often presents with a cystic area visible on ultrasound that may be less visible in the operating room due to edema." (host_summary) [Ep 3 · 11:51](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=711)
- "If the fallopian tube is black and edematous after detorsion and adequate time, consideration should be given to management of that tube." (host_summary) [Ep 3 · 12:08](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=728)
- "It is best to avoid removing the ovary in torsion because it may regain functionality even if it appears black." (host_summary) [Ep 3 · 12:23](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=743)
- "Doctor Breech advises against oophoropexy (ovarian fixation) and instead recommends detorsion with subsequent monitoring." (host_summary) [Ep 3 · 12:31](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=751)
- "Chronic pancreatitis causes pancreatic insufficiency and damage to islet cells." (host_summary) [Ep 3 · 13:08](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=788)
- "TPIAT involves complete removal of pancreas and spleen, extraction of islet cells in a specialized lab, then injection of those cells into the portal vein." (host_summary) [Ep 3 · 13:17](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=797)
- "In the acute postoperative period after TPIAT, glucose must be managed externally; all patients are on insulin in the ICU to avoid stressing the islet cells, allowing them to implant and find new vessels from the liver without doing work." (clinical) [Ep 3 · 13:27](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=807)
- "Many chronic pancreatitis patients have gene mutations triggering recurrent attacks, causing the gland to replace normal cells with fibrosis." (host_summary) [Ep 3 · 13:45](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=825)
- "Performing surgical resection for chronic pancreatitis without islet cell extraction may result in continued pancreatitis attacks and increased diabetes risk due to reduced pancreatic parenchyma." (host_summary) [Ep 3 · 13:55](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=835)
- "The American Pediatric Surgical Association (APSA) released revised guidelines for blunt hepatosplenic trauma management including four categories: admission location, procedures, discharge timing, and post-discharge management." (host_summary) [Ep 3 · 14:52](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=892)
- "For grades 1 and 2 blunt liver and spleen trauma, hemodynamically stable patients can be monitored and considered for discharge from the emergency department." (host_summary) [Ep 3 · 15:13](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=913)
- "In one institution's practice, 80% of pediatric trauma patients are transfers who have already had CBC at the referring hospital; hemodynamically normal children go to the floor without repeat hemoglobin." (clinical) [Ep 3 · 15:27](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=927)
- "Data shows hemodilution occurs in trauma, and patients more likely to fail non-operative management have initial hemoglobin less than 9.25 g/dL." (host_summary) [Ep 3 · 15:43](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=943)
- "For blunt liver and spleen trauma, increasing evidence supports treating the patient based on signs and symptoms rather than solely on injury grade." (host_summary) [Ep 3 · 16:04](https://library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=964)
- "Children account for approximately 5% of all patients with achalasia." (host_summary) [Ep 1 · 0:06](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=6)
- "The Heller esophagocardiomyotomy is the most definitive treatment for achalasia." (host_summary) [Ep 1 · 0:20](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=20)
- "The four major steps of Heller myotomy are mobilization of the distal esophagus, a long esophagomyotomy carried onto the stomach as a cardiomyotomy, and an anterior fundoplication to cover the myotomy and decrease gastroesophageal reflux." (host_summary) [Ep 1 · 0:35](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=35)
- "The most critical part of the Heller operation is the myotomy, where mucosal perforations can occur, typically secondary to burns from an energy source such as hook cautery." (host_summary) [Ep 1 · 1:00](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=60)
- "Myotomy can be performed in a precise manner without the use of any energy source." (host_summary) [Ep 1 · 1:20](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=80)
- "An 8-centimeter silk suture is used to measure the distance from the diaphragm to the cardia during the procedure." (host_summary) [Ep 1 · 2:10](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=130)
- "The posterior attachments of the esophagus to the hiatus are kept intact during mobilization." (host_summary) [Ep 1 · 2:20](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=140)
- "An arthroscopic knife introduced through the abdominal wall is used to initiate the esophageal myotomy, then scissors deepen the myotomy." (host_summary) [Ep 1 · 2:30](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=150)
- "A right-angle grasper spreads the muscle fibers, and once the longitudinal muscle is mobilized, traction in opposite directions achieves satisfactory separation without injury to the submucosa." (host_summary) [Ep 1 · 2:45](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=165)
- "The myotomy proceeds from distal to proximal, with the outer longitudinal and inner circular layers well identified, including individual circular fibers which can be precisely divided by the tip of the instrument with the heel protecting the submucosa." (host_summary) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=180)
- "The dissection is bloodless when performed with this technique." (host_summary) [Ep 1 · 3:20](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=200)
- "After reaching the proximal extent of the esophagus at the diaphragm, the direction of dissection is reversed to extend the myotomy onto the gastric cardia for approximately 2 centimeters." (host_summary) [Ep 1 · 3:25](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=205)
- "The myotomy is tested by pulling the nasogastric tube back to the hiatus and performing air insufflation." (host_summary) [Ep 1 · 3:40](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=220)
- "The procedure is completed with an anterior fundoplication." (host_summary) [Ep 1 · 3:50](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=230)
- "The patient had near-complete resolution of symptoms postoperatively." (host_summary) [Ep 1 · 3:55](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=235)
- "A postoperative contrast study confirmed resolution of the esophageal obstruction." (host_summary) [Ep 1 · 4:00](https://library.globalcastmd.com/watch/laparoscopic-heller-myotomy-2252?t=240)
- "The three types of achalasia (Chicago classification) all require the same treatment approach, but type 2 responds best to surgery while type 3 has the worst outcomes" (clinical) [Ep 2 · 1:41](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=101)
- "Type 3 achalasia does not respond well to treatments and recurrences happen much more frequently in patients with type 3" (clinical) [Ep 2 · 1:41](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=101)
- "The Eckardt score consists of four components: weight loss, dysphagia, chest pain, and regurgitation, used both for diagnosis and clinical follow-up" — Mikhail Petrozan (clinical) [Ep 2 · 4:02](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=242)
- "A 2015 IPEG survey showed 95% of pediatric surgeons would perform fundoplication with Heller myotomy" — Tim Kaine (host_summary) [Ep 2 · 5:10](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=310)
- "At Children's National, fundoplication is not offered with Heller myotomy because anterior wraps have caused esophageal torquing as children grow, requiring takedown of the wrap" (clinical) [Ep 2 · 5:10](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=310)
- "In adult literature, when Heller myotomy is performed, good evidence shows fundoplication is not necessary" — Tim Kaine (host_summary) [Ep 2 · 5:10](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=310)
- "Approximately 50% of pediatric achalasia patients have had some intervention (dilation or Botox) before definitive surgery" — Tim Kaine (epidemiological) [Ep 2 · 5:10](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=310)
- "Botox injection causes significant scar tissue formation, while prior dilations cause minimal fibrosis that is not problematic during surgery" — Tim Kaine (clinical) [Ep 2 · 5:10](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=310)
- "The standard myotomy extends approximately 2 centimeters onto the stomach and 4-5 centimeters up the esophagus, for a total average length of 6-7 centimeters" — Tim Kaine (clinical) [Ep 2 · 12:06](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=726)
- "Symptoms within one year after myotomy suggest incomplete myotomy, while later recurrence may represent true recurrent achalasia related to growth" — Tim Kaine (opinion) [Ep 2 · 12:06](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=726)
- "Manometry in achalasia patients often continues to show abnormal findings even after successful treatment, making it less useful for post-operative surveillance" — Mikhail Petrozan (clinical) [Ep 2 · 13:19](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=799)
- "Endoflip measures esophageal distensibility and diameter, providing real-time feedback during myotomy to determine adequacy of the procedure" (clinical) [Ep 2 · 15:41](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=941)
- "The first human POEM case was performed by Inoue in 2010" (clinical) [Ep 2 · 16:48](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1008)
- "Children's National performed their first POEM in 2015 after a two-year process to obtain equipment, with initial cases having conversion to Heller as backup" (clinical) [Ep 2 · 17:06](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- "The learning curve for POEM is approximately 20 cases, with mastery around 60 cases according to adult literature" (host_summary) [Ep 2 · 17:06](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- "POEM offers 360 degrees of myotomy options compared to approximately 180 degrees with laparoscopic Heller, and avoids hiatal dissection which reduces reflux risk" (clinical) [Ep 2 · 17:06](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- "In the Children's National series of 73 POEM cases, the re-intervention rate requiring balloon dilation within one year was 15%, similar to their historical Heller experience" — Tim Kaine (epidemiological) [Ep 2 · 17:06](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- "Five redo POEM procedures were performed, with three of the five being in patients with type 3 achalasia who presented with recurrent symptoms within one year" — Tim Kaine (epidemiological) [Ep 2 · 17:06](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- "In the Children's National POEM series, 11% were type 3 achalasia (higher than most literature), 62% were type 2, with type 2 patients having the best outcomes" — Tim Kaine (epidemiological) [Ep 2 · 17:06](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- "Pediatric patients biopsied one year after POEM showed a reflux rate of approximately 5%, compared to 50% in adult POEM patients" — Mikhail Petrozan (epidemiological) [Ep 2 · 8:59](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=539)
- "Type 2 achalasia patients have essentially no peristalsis, so opening the LES allows them to swallow effectively, while type 1 patients have spastic esophagus causing more persistent symptoms" — Tim Kaine (clinical) [Ep 2 · 17:06](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- "Children's National currently performs approximately 15 POEM procedures per year, with initial years having much lower volumes (2-3 cases)" (epidemiological) [Ep 2 · 17:06](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1026)
- "Many patients are now specifically requesting POEM after doing their own research, rather than considering Heller myotomy" — Whit Holcomb (opinion) [Ep 2 · 24:03](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1443)
- "The POEM technique has been successfully adapted for pyloric myotomy (G-POEM) in gastroparesis patients" (clinical) [Ep 2 · 25:26](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1526)
- "Only approximately 10% of pediatric surgeons perform thoracoscopic tracheoesophageal fistula repair, illustrating the challenge of disseminating advanced techniques" — Whit Holcomb (epidemiological) [Ep 2 · 22:45](https://library.globalcastmd.com/watch/update-course-2023-updates-in-pediatric-achalasia-management-7270?t=1365)

## Changelog
- Sep 21: 3 items added automatically

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