International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video).
Gastrointest Endosc
; 81(5): 1170-7, 2015 May.
Article
en En
| MEDLINE
| ID: mdl-25634487
ABSTRACT
BACKGROUND:
Limited data exist on the use of peroral endoscopic myotomy (POEM) for therapy of spastic esophageal disorders (SEDs).OBJECTIVE:
To study the efficacy and safety of POEM for the treatment of patients with diffuse esophageal spasm, jackhammer esophagus, or type III (spastic) achalasia.DESIGN:
Retrospective study.SETTING:
International, multicenter, academic institutions. PATIENTS All patients who underwent POEM for treatment of SEDs refractory to medical therapy at 11 centers were included.INTERVENTIONS:
POEM. MAIN OUTCOME MEASUREMENTS Eckardt score and adverse events.RESULTS:
A total of 73 patients underwent POEM for treatment of SEDs (diffuse esophageal spasm 9, jackhammer esophagus 10, spastic achalasia 54). POEM was successfully completed in all patients, with a mean procedural time of 118 minutes. The mean length of the submucosal tunnel was 19 cm, and the mean myotomy length was 16 cm. A total of 8 adverse events (11%) occurred, with 5 rated as mild, 3 moderate, and 0 severe. The mean length of hospital stay was 3.4 days. There was a significant decrease in Eckardt scores after POEM (6.71 vs 1.13; P = .0001). Overall, clinical response was observed in 93% of patients during a mean follow-up of 234 days. Chest pain significantly improved in 87% of patients who reported chest pain before POEM. Repeat manometry after POEM was available in 44 patients and showed resolution of initial manometric abnormalities in all cases.LIMITATIONS:
Retrospective design and selection bias.CONCLUSION:
POEM offers a logical therapeutic modality for patients with SEDs refractory to medical therapy. Results from this international study suggest POEM as an effective and safe platform for these patients.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Espasmo Esofágico Difuso
/
Acalasia del Esófago
/
Cirugía Endoscópica por Orificios Naturales
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
Límite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Gastrointest Endosc
Año:
2015
Tipo del documento:
Article
País de afiliación:
Estados Unidos