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Peroral endoscopic myotomy for the treatment of achalasia after failed pneumatic dilation.
Jin, Hong; Wang, Bin; Zheng, Zhong-Qing; Zhang, Li-Li; Chen, Qiu-Yu; Zhao, Chun Shan; Wang, Bang-Mao; Zhao, Wei.
Afiliação
  • Jin H; Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, 300070, China.
  • Wang B; Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, 300070, China.
  • Zheng ZQ; Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, 300070, China.
  • Zhang LL; Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, 300070, China.
  • Chen QY; Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, 300070, China.
  • Zhao CS; Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, 300070, China.
  • Wang BM; Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, 300070, China.
  • Zhao W; Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, 300070, China. zhaoweihotstone@yeah.net.
Surg Endosc ; 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33398574
ABSTRACT
BACKGROUND AND

AIMS:

POEM is a rescue endoscopic therapy for patients who had previously failed surgical or endoscopic treatment. However, data regarding its effectiveness after failed pneumatic dilation (PD) and its long-term effects are limited. We aimed to retrospectively investigate the long-term outcomes in patients who had undergone POEM after failed PD.

METHODS:

Data from 66 achalasia patients with a 2-year follow-up period were analyzed. Intraprocedural events were compared between the first POEM group (patients without prior-endoscopic intervention) and prior PD group (patients who had pre-POEM PD). Symptom evaluation, HRM and 24 h-pH DeMeester scores between the two groups were performed at 2 years after the POEM procedure. Muscularis externa samples were obtained from the lower esophagus using POEM to assess the muscle fibrosis with Azan-Mallory staining.

RESULTS:

POEM was successfully performed for all achalasia patients. During the 2-year follow-up period, the success rate of POEM was 96.15% (25/26) for patients with prior PD and 95% (38/40) with primary POEM. For patients with type II achalasia and who underwent prior PD, the post-procedure DeMeester score was higher compared to patients who underwent POEM only (P < 0.05). A larger number of patients who underwent primary POEM (27.50%, 11/40) complained of mild heartburn compared to patients who underwent POEM after PD (7.69%, 2/26) (P < 0.05). With regards to fibrosis, the majority of patients who underwent POEM only were classified as F-1 (45.00%, 18/40), while the majority of patients who underwent prior PD were classified as F-2 (42.3%, 11/26). The degree of fibrosis was significantly different between the two groups (P < 0.05). Both surgical time and prior PD were correlated with the degree of fibrosis (P < 0.05).

CONCLUSIONS:

Despite the technical challenges, pre-POEM endoscopic treatment does not impact the safety and efficacy of POEM in achalasia patients. Longer follow-up studies using larger cohorts are needed to determine long-term outcomes and complications of POEM.
Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Tipo de estudo: Estudo observacional / Estudo prognóstico Idioma: Inglês Assunto da revista: Diagnóstico por Imagem / Gastroenterologia Ano de publicação: 2021 Tipo de documento: Artigo País de afiliação: China

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Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Tipo de estudo: Estudo observacional / Estudo prognóstico Idioma: Inglês Assunto da revista: Diagnóstico por Imagem / Gastroenterologia Ano de publicação: 2021 Tipo de documento: Artigo País de afiliação: China