Complications after Heller myotomy in children: a national multicenter study on the impact of prior endoscopic dilatation and identification of risk factors.
Surg Endosc
; 38(7): 3602-3608, 2024 Jul.
Article
in En
| MEDLINE
| ID: mdl-38769183
ABSTRACT
BACKGROUND:
Although esophageal achalasia has been historically treated by Heller myotomy, endoscopic esophageal dilatations are nowadays often the first-line treatment in children. The aim was to assess whether performing an endoscopic dilatation before a Heller myotomy is associated with higher risks of esophageal perforation in children.METHODS:
A retrospective multicentric study was performed, including children that underwent a Heller myotomy (2000-2022, 10 centers). Two groups were compared based on the history of previous dilatation before myotomy. Outcomes esophageal perforation (intra-operative or secondary) and post-operative complications requiring surgery (Clavien-Dindo III). Statistics Comparisons using contingency tables or Kruskal-Wallis when appropriate. Statisticalsignificance:
p-value < 0.05.RESULTS:
A Heller myotomy was performed in 77 children (median age 11.8 years), with prior endoscopic dilatation in 53% (n = 41). A laparoscopic approach was used in 90%, with associated fundoplication in 95%. Esophageal perforation occurred in 19% of children (n = 15), including 12 patients with intra-operative mucosal tear and 3 with post-operative complications related to an unnoticed esophageal perforation. Previous endoscopic dilatation did not increase the risk of esophageal perforation (22% vs 17%, OR 1.4, 95%CI 0.43-4.69). Post-operative complications occurred in 8% (n = 6), with similar rates regardless of prior endoscopic dilatation. Intra-operative mucosal tear was the only risk factor for post-operative complications, increasing the risk of complications from 5 to 25% (OR 6.89, 95%CI 1.38-31.87).CONCLUSIONS:
Prior endoscopic dilatations did not increase the risk of esophageal perforation or postoperative complications of Heller myotomy in this cohort of children with achalasia. Mucosal tear was identified as a risk factor for post-operative complications.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Postoperative Complications
/
Esophageal Achalasia
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Esophagoscopy
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Dilatation
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Esophageal Perforation
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Heller Myotomy
Limits:
Adolescent
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Child
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Child, preschool
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Female
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Humans
/
Male
Language:
En
Journal:
Surg Endosc
Journal subject:
DIAGNOSTICO POR IMAGEM
/
GASTROENTEROLOGIA
Year:
2024
Type:
Article
Affiliation country:
France