Peroral endoscopic myotomy as salvation technique post-Heller: International experience.
Dig Endosc
; 30(1): 52-56, 2018 Jan.
Article
em En
| MEDLINE
| ID: mdl-28691186
ABSTRACT
BACKGROUND:
Treatment for achalasia has traditionally been Heller myotomy (HM). Despite its excellent efficacy rate, a number of patients remain symptomatic post-procedure. Limited data exist as to the best management for recurrence of symptoms post-HM. We present an international, multicenter experience evaluating the efficacy and safety of post-HM peroral endoscopic myotomy (POEM).METHODS:
Patients who underwent POEM post-HM from 13 centers from January 2012 to January 2017 were included as part of a prospective registry. Technical success was defined as successful completion of the myotomy. Clinical success was defined as an Eckardt score of ≤3 on 12-month follow up. Adverse events (AE) including anesthesia-related, operative, and postoperative complications were recorded.RESULTS:
Fifty-one patients were included in the study (mean age 54.2, 47% male). Technical success was achieved in 100% of patients. Clinical success on long-term follow up was achieved in 48 patients (94%), with a mean change in Eckardt score of 6.25. Seven patients (13%) had AE six experienced periprocedural mucosal defect treated endoscopically and two patients developed mediastinitis treated conservatively.CONCLUSION:
For patients with persistent symptoms after HM, POEM is a safe salvation technique with good short-term efficacy. As a result of the challenge associated with repeat HM, POEM might become the preferred technique in this patient population. Further studies with longer follow up are needed.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Acalasia Esofágica
/
Esofagoscopia
/
Terapia de Salvação
/
Esfíncter Esofágico Inferior
/
Cirurgia Endoscópica por Orifício Natural
/
Miotomia
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Observational_studies
Limite:
Humans
/
Middle aged
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article