Long-term outcomes following POEM for non-achalasia motility disorders of the esophagus.

Autor: Filicori F; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 3805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA.; Foundation for Surgical Innovation and Education, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA., Dunst CM; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 3805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA. cdunst@orclinic.com.; Foundation for Surgical Innovation and Education, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA. cdunst@orclinic.com., Sharata A; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 3805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA.; Foundation for Surgical Innovation and Education, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA., Abdelmoaty WF; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 3805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA.; Foundation for Surgical Innovation and Education, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA., Zihni AM; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 3805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA.; Foundation for Surgical Innovation and Education, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA., Reavis KM; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 3805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA.; Foundation for Surgical Innovation and Education, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA., Demeester SR; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 3805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA.; Foundation for Surgical Innovation and Education, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA., Swanström LL; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 3805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA.; Institut Hospitalo Universitaire Strasbourg, 1, Place de l'Hôpital, 97000, Strasbourg, France.; Foundation for Surgical Innovation and Education, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2019 May; Vol. 33 (5), pp. 1632-1639. Date of Electronic Publication: 2018 Sep 19.
DOI: 10.1007/s00464-018-6438-z
Abstrakt: Background: Optimal treatment for symptomatic patients with non-achalasia motility disorders (NAD) such as diffuse esophageal spasm, esophagogastric junction outlet obstruction, and hypercontractile disorder is not well established. POEM has been offered to these patients since it is a less invasive and less morbid procedure but long-term outcomes remain undetermined. The aim of this study was to assess long-term outcomes of POEM for patients with NAD.
Methods: Records of 40 consecutive patients undergoing POEM for NAD from May 2011 to January 2016 at a single center were retrospectively reviewed. Preoperative and 6-month postoperative symptom scores, high-resolution manometry, pH testing, and timed barium swallow (TBS) data were collected. Patients were contacted by phone to obtain long-term symptom assessment. Symptoms were assessed using a standardized symptom questionnaire with scores for symptoms graded according to frequency and the Eckardt score.
Results: Ten percent had minor complications with no postoperative sequelae. 90% of patients had significant improvement in their mean Eckardt scores (5.02 vs. 1.12, p < 0.001) at early follow-up. Improvements in chest pain (1.02-0.36, p = 0.001) and dysphagia (2.20 vs. 0.40, p = 0.001) were seen. Significant improvements in manometric pressures and esophageal emptying on TBS were observed across groups. 38% (10/26) of patients had a postoperative pH score > 14.72. Long-term (median 48 months) symptom scores were obtained from 29 (72.5%) patients. 82% of patients (24/29) had sustained symptom improvement. A small increase in the dysphagia scores was reported in the long-term follow-up compared to the immediate postoperative period (0.36-0.89, p = 0.046).
Conclusions: Chest pain and dysphagia are effectively palliated with POEM in patients with non-achalasia disorders of the esophagus. Significant improvements are durable in long-term follow-up. Despite earlier reports by our group suggesting possible inferior outcomes from POEM for this difficult group of patients, this study is far more encouraging. POEM should be considered in the treatment of patients with non-achalasia disorders of the esophagus.
Databáze: MEDLINE
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