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When less is more: lower esophageal sphincter-preserving peroral endoscopic myotomy is effective for non-achalasia esophageal motility disorders.
Perananthan, Varan; Gupta, Sunil; Whitfield, Anthony; Craciun, Ana; Cronin, Oliver; O'Sullivan, Timothy; Byth, Karen; Sidhu, Mayenaaz; Hourigan, Luke F; Raftopoulos, Spiro; Burgess, Nicholas G; Bourke, Michael J.
Afiliação
  • Perananthan V; Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia.
  • Gupta S; School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia.
  • Whitfield A; Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia.
  • Craciun A; School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia.
  • Cronin O; Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia.
  • O'Sullivan T; School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia.
  • Byth K; Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia.
  • Sidhu M; Gastroenterology and Hepatology, Centro Hospitalar Universitario de Lisboa Norte, Lisbon, Portugal.
  • Hourigan LF; Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia.
  • Raftopoulos S; School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia.
  • Burgess NG; Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia.
  • Bourke MJ; School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia.
Endoscopy ; 56(6): 431-436, 2024 Jun.
Article em En | MEDLINE | ID: mdl-38183976
ABSTRACT

BACKGROUND:

Non-achalasia esophageal motility disorders (NAEMDs), encompassing distal esophageal spasm (DES) and hypercontractile esophagus (HCE), are rare conditions. Peroral endoscopic myotomy (POEM) is a promising treatment option. In NAEMDs, unlike with achalasia, the lower esophageal sphincter (LES) functions normally, suggesting the potential of LES preservation during POEM.

METHODS:

This retrospective two-center observational study focused on patients undergoing LES-preserving POEM (LES-POEM) for NAEMD. Eckardt scores were assessed pre-POEM and at 6, 12, and 24 months post-POEM, with follow-up endoscopy at 6 months to evaluate for reflux esophagitis. Clinical success, defined as an Eckardt score ≤3, served as the primary outcome.

RESULTS:

227 patients were recruited over 84 months until May 2021. Of these, 16 underwent LES-POEM for an NAEMD (9 with HCE and 7 with DES). The median pre-POEM Eckardt score was 6.0 (interquartile range [IQR] 5.0-7.0), which decreased to 1.0 (IQR 0.0-1.8; P<0.001) 6 months post-POEM. This was sustained at 24 months, with an Eckardt score of 1.0 (IQR 0.0-1.8; P<0.001). Two patients (12.5%) developed Los Angeles grade A or B esophagitis.

CONCLUSIONS:

LES-POEM for NAEMD demonstrates favorable clinical outcomes, with infrequent esophagitis and reintervention for LES dysfunction rarely required.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transtornos da Motilidade Esofágica / Esfíncter Esofágico Inferior / Miotomia Tipo de estudo: Observational_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Endoscopy Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Austrália

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transtornos da Motilidade Esofágica / Esfíncter Esofágico Inferior / Miotomia Tipo de estudo: Observational_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Endoscopy Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Austrália