Management of recurrent symptoms after per-oral endoscopic myotomy in achalasia.
Gastrointest Endosc
; 87(1): 95-101, 2018 Jan.
Article
em En
| MEDLINE
| ID: mdl-28478028
ABSTRACT
BACKGROUND AND AIMS:
Per-oral endoscopic myotomy (POEM) has been rapidly gaining ground as a treatment for achalasia. Although POEM is a safe and effective treatment, a subset of patients has persistent or recurrent symptoms after POEM. This study aimed to examine the efficacy of different retreatments after failed POEM.METHODS:
POEM was performed on 441 patients with achalasia at 3 tertiary-care hospitals between 2010 and 2015. A review of prospectively collected data was conducted. All patients with achalasia with significant persistent or recurrent symptoms within 3 years after POEM, defined as an Eckardt symptom score >3, were included.RESULTS:
Forty-three of 441 patients (9.8%) had persistent or recurrent symptoms after POEM, of which 34 (8%) received 1 or more retreatments. Retreatment with laparoscopic Heller myotomy and retreatment with POEM showed a modest efficacy of 45% and 63%, respectively, whereas pneumatic dilatation showed a poor efficacy of only 0% to 20%, depending on the size of the balloon. Male patients were more likely to have retreatment failure than female patients (P = .038).CONCLUSIONS:
In patients with achalasia with persistent or recurrent symptoms after failed POEM, retreatment with laparoscopic Heller myotomy or retreatment with POEM has a higher efficacy than retreatment with pneumatic dilatations. Failure of retreatment occurred more often in male patients.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Acalasia Esofágica
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Endoscopia do Sistema Digestório
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Dilatação
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Cirurgia Endoscópica por Orifício Natural
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Miotomia de Heller
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Miotomia
Tipo de estudo:
Diagnostic_studies
Limite:
Adolescent
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Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article