Efficacy of peroral endoscopic myotomy for esophageal motility disorders after gastric surgery: Japan Achalasia Multicenter Study.

Autor: Nakamura J; Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan., Sato H; Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA., Onimaru M; Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan., Abe H; Department of Gastroenterology, Kobe University Hospital, Hyogo, Japan., Shiwaku H; Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan., Shiota J; Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan., Sato C; Department of Surgery, Tohoku University School of Medicine, Miyagi, Japan., Sakae H; Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan., Ominami M; Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan., Hata Y; Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan., Fukuda H; Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan., Ogawa R; Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan., Tatsuta T; Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan., Ikebuchi Y; Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori, Japan., Yokomichi H; Department of Health Sciences, University of Yamanashi, Yamanashi, Japan., Takuto H; Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan., Inoue H; Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
Jazyk: angličtina
Zdroj: Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society [Dig Endosc] 2022 Nov; Vol. 34 (7), pp. 1394-1402. Date of Electronic Publication: 2022 Jul 28.
DOI: 10.1111/den.14369
Abstrakt: Objectives: Patients with esophageal motility disorders (EMDs) including achalasia after gastric surgery have not been thoroughly characterized. Furthermore, the efficacy of peroral endoscopic myotomy (POEM) in this population should be clarified.
Methods: In this retrospective multicenter study of 3707 patients with EMDs, 31 patients (0.8%) had a history of gastric surgery. Patient characteristics and POEM efficacy were compared between patients with and without previous gastric surgery.
Results: In patients with EMD after gastric surgery, age at EMD diagnosis was higher (72.0 years), male sex was predominant (90.3%), and the American Society of Anesthesiologists physical status score was higher (≥II, 48.4%). High-resolution manometry (HRM) findings did not reveal significant differences. In patients who underwent gastric surgery, atrophic gastritis was common (80.6%), and gastric cancer was the primary surgical indication (32.3%). Distal gastrectomy was performed in 28 patients (90.3%). POEM was effective (3.3% adverse events; 100% treatment success). The incidence rates of reflux esophagitis (RE) and symptomatic gastroesophageal reflux disease (GERD) were 60.0% and 16.7%, respectively, without significant intergroup differences, and severe RE was not observed in the long-term follow-up. Extended gastric myotomy was a risk factor for RE.
Conclusion: Patients with gastric surgery often present severe disease manifestations; the surgical indication is mainly gastric cancer. HRM findings can be similarly used for diagnosis in patients with and without gastric surgery. POEM maintains safety and efficacy with acceptable RE and symptomatic GERD rates. To prevent RE, extended myotomy should be avoided.
(© 2022 Japan Gastroenterological Endoscopy Society.)
Databáze: MEDLINE
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