Per oral endoscopic myotomy: Another tool in the toolbox
| Autor: | Monica Ray, Siva Raja, Madhu R. Sanaka, Scott Gabbard, Prashanthi N. Thota, Andrew Tang, Sudish C. Murthy, Malav P. Parikh, Neha Wadhwa, Usman Ahmad, Hafiz Umair Siddiqui |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Pulmonary and Respiratory Medicine
Myotomy Male Natural Orifice Endoscopic Surgery medicine.medical_specialty Time Factors Databases Factual medicine.medical_treatment Perforation (oil well) Clinical Decision-Making Operative Time Achalasia 030204 cardiovascular system & hematology Esophageal Sphincter Lower Decision Support Techniques 03 medical and health sciences 0302 clinical medicine Postoperative Complications Pyloromyotomy Interquartile range Risk Factors medicine Humans High resolution manometry Aged Heller myotomy medicine.diagnostic_test Esophagogastroduodenoscopy business.industry Recovery of Function Middle Aged medicine.disease Surgery Esophageal Achalasia Treatment Outcome 030228 respiratory system GERD Female Cardiology and Cardiovascular Medicine business Algorithms |
| Zdroj: | The Journal of thoracic and cardiovascular surgery. 158(3) |
| ISSN: | 1097-685X |
| Popis: | Use of per oral endoscopic myotomy is increasing for the treatment of achalasia, with potential for rapid recovery and less invasiveness. We report our experience with per oral endoscopic myotomy to better understand how it fits into a modern paradigm of achalasia management.A total of 152 patients with achalasia underwent per oral endoscopic myotomy from April 2014 to March 2018. Type II achalasia was the most prominent subtype in 69 patients (49%), and 33 patients (21.5%) had a prior Heller myotomy. Postoperative Eckardt scores, integrated relaxation pressure, and timed barium esophagram column height and width at 2 months were compared with preoperative measurements.Per oral endoscopic myotomy was completed in 149 patients (98%). Median operative time was 96 minutes (75 minutes for the last 30 cases), and length of stay was 1 day (interquartile range, 1-2). The most common morbidities were mucosal perforation in 2 patients (1.3%) and bleeding in 3 patients (2.0%), although no nonendoscopic intervention was required. Mortality was zero. Postoperatively, the median Eckardt score decreased from 6 to 0 (P .001), residual lower esophageal sphincter pressure decreased from 22 mm Hg to 6 mm Hg (P .001), and timed barium esophagram column height and width at 5 minutes decreased from 8 and 2.5 cm to 1.5 and 0.8 cm (P .001), respectively. Median time to return to daily activity was 7 days; 49 patients (49.5%) had abnormal acid reflux on 24-hour pH testing postprocedure.Per oral endoscopic myotomy is a safe and effective intervention that provides clear subjective and objective improvement in patients with achalasia. High postprocedure acid reflux raises concern about future sequelae if used in a nonselective fashion. |
| Databáze: | OpenAIRE |
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