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1.
Endoscopy ; 51(4): 350-354, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30630196

RESUMEN

BACKGROUND: Peroral endoscopic myotomy (POEM) is a recognized technique for patients with achalasia. We aimed to evaluate the feasibility of using a small-caliber endoscope (thin-POEM) to perform POEM in patients with achalasia. METHODS: Naïve or previously treated patients were included between February 2016 and April 2018. A small-caliber (5.9 mm) nasoendoscope was used, with a modified closure method using cyanoacrylate. Strict follow-up was performed. RESULTS: 45 patients were included, aged 45.5 years (interquartile range [IQR] 22 - 69); 53 % (24/45) had type II achalasia. Median total time for thin-POEM was 54 minutes (IQR 37 - 77) and median myotomy length was 13.5 cm (IQR 6 - 20). Results pre-procedure and 3 months post were Eckardt score 10 vs. 1 (P < 0.001), integrated relaxation pressure (IRP) 25.3 vs. 8.5 mmHg (P < 0.001), and timed barium esophagram (TBE) 100 % severely delayed vs. 86 % normal (P < 0.001), respectively. Type III patients had the longest thin-POEM times (median 58 minutes [IQR 52 - 77]). Reflux was confirmed at 3 months clinically in 17 % of patients, endoscopically in 20 %, and on pH monitoring in 53 %. At 6 months and 12 months, 40 % and 33 % of patients remained positive on pH monitoring and were medically managed. CONCLUSIONS: Thin-POEM seems to be a safe, effective, and efficient procedure for POEM in patients with achalasia, with good short-term follow-up results.


Asunto(s)
Endoscopios , Endoscopía del Sistema Digestivo , Acalasia del Esófago , Reflujo Gastroesofágico , Miotomía , Cirugía Endoscópica por Orificios Naturales , Complicaciones Posoperatorias/diagnóstico , Endoscopía del Sistema Digestivo/efectos adversos , Endoscopía del Sistema Digestivo/instrumentación , Endoscopía del Sistema Digestivo/métodos , Diseño de Equipo , Acalasia del Esófago/diagnóstico , Acalasia del Esófago/epidemiología , Acalasia del Esófago/cirugía , Monitorización del pH Esofágico/métodos , Monitorización del pH Esofágico/estadística & datos numéricos , Femenino , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/etiología , Humanos , Masculino , México , Persona de Mediana Edad , Miotomía/efectos adversos , Miotomía/instrumentación , Miotomía/métodos , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Cirugía Endoscópica por Orificios Naturales/instrumentación , Cirugía Endoscópica por Orificios Naturales/métodos , Evaluación de Procesos y Resultados en Atención de Salud , Estudios Retrospectivos
2.
J Pediatr (Rio J) ; 85(1): 84-6, 2009.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-19198732

RESUMEN

OBJECTIVE: To investigate the causes and degree of interobserver variability in esophageal pH monitoring for the diagnosis of gastroesophageal reflux. METHODS: This retrospective study included all children (n = 72) who underwent pH monitoring during 1 year at Maxima Medical Centre in Veldhoven, the Netherlands. RESULTS: An interobserver variability of 18% was found. Variability was caused by differences in opinion about the duration of registration, doubts about probe position, artifacts and drift of baseline pH. CONCLUSIONS: Most of these problems can be eliminated by posttest calibration and assessment of the pH electrode position. However, a clear definition of monitoring artifacts is lacking. This study shows that mutual agreement in the interpretation of pH studies was fair (kappa coefficient of 0.70).


Asunto(s)
Monitorización del pH Esofágico/estadística & datos numéricos , Reflujo Gastroesofágico/diagnóstico , Calibración/normas , Electrodos Implantados/normas , Femenino , Humanos , Lactante , Masculino , Variaciones Dependientes del Observador , Estudios Retrospectivos
3.
J. pediatr. (Rio J.) ; J. pediatr. (Rio J.);85(1): 84-86, jan.-fev. 2009. tab
Artículo en Inglés, Portugués | LILACS | ID: lil-507704

RESUMEN

OBJETIVO: O monitoramento do pH esofágico é considerado o método mais confiável para diagnosticar o refluxo gastroesofágico. No entanto, a interpretação do mesmo estudo de pH pode diferir entre observadores. Neste estudo, investigamos as causas e o grau de variabilidade entre observadores. MÉTODOS: Este estudo retrospectivo incluiu todas as crianças (n = 72) que realizaram monitoramento de pH durante 1 ano no Maxima Medical Centre, em Veldhoven, Holanda. RESULTADOS: Foi encontrada uma variabilidade de 18 por cento entre observadores. A variabilidade foi causada por diferenças de opinião sobre a duração do registro, dúvidas sobre a posição da sonda, artefatos e flutuação do pH de base. CONCLUSÕES: A maioria desses problemas pode ser eliminada por avaliação da posição do eletrodo de pH e calibração pós-teste. No entanto, ainda falta uma definição clara dos artefatos de monitoramento. Este estudo mostra que a concordância mútua na interpretação dos estudos de pH foi regular (coeficiente kappa de 0,70).


OBJECTIVE: To investigate the causes and degree of interobserver variability in esophageal pH monitoring for the diagnosis of gastroesophageal reflux. METHODS: This retrospective study included all children (n = 72) who underwent pH monitoring during 1 year at Maxima Medical Centre in Veldhoven, the Netherlands. RESULTS: An interobserver variability of 18 percent was found. Variability was caused by differences in opinion about the duration of registration, doubts about probe position, artifacts and drift of baseline pH. CONCLUSIONS: Most of these problems can be eliminated by posttest calibration and assessment of the pH electrode position. However, a clear definition of monitoring artifacts is lacking. This study shows that mutual agreement in the interpretation of pH studies was fair (kappa coefficient of 0.70).


Asunto(s)
Femenino , Humanos , Lactante , Masculino , Monitorización del pH Esofágico/estadística & datos numéricos , Reflujo Gastroesofágico/diagnóstico , Calibración/normas , Electrodos Implantados/normas , Variaciones Dependientes del Observador , Estudios Retrospectivos
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