Efficacy and Safety of Endoscopic Minimally Invasive Therapeutic Procedures of the Foregut.

Abstract

In the past decade, there has been significant progress in the field of interventional therapeutic endoscopy. As a result, the management of foregut diseases, such as gastroesophageal reflux disease (GERD), achalasia, Zenker's diverticulum, early esophageal neoplasia, etc. has undergone a paradigm shift from traditional surgical to minimally invasive endoscopic approaches. My dissertation document includes projects that assess the efficacy and safety of notable endoscopic therapeutic procedures for two foregut diseases, i.e., GERD and achalasia. Transoral incisionless fundoplication (TIF) is a minimally invasive endoscopic fundoplication technique for the surgical treatment of chronic or refractory GERD. Its efficacy against typical GERD symptoms has been reported but there is limited data on its effectiveness against atypical GERD symptoms. Therefore, we conducted a systematic review and meta-analysis to assess the efficacy and safety of TIF to improve atypical GERD symptoms in patients with chronic or refractory GERD. Per-oral endoscopic myotomy (POEM) is a minimally invasive endoscopic myotomy procedure for the management of achalasia. There is limited literature on the direct comparison of the outcomes of all major treatment approaches for achalasia in real-world database. In our second project, we utilized the 2016-2019 National Readmission Database to compare safety and short-term outcomes following POEM, Laparoscopic Heller's myotomy (LHM) and Pneumatic Dilation (PD) in patients with achalasia.