Per-oral endoscopic myotomy for achalasia. Are results comparable to laparoscopic Heller myotomy?
| Autor: | Lars Lundell, Anders Thorell, Bengt Håkanson, Jon A. Tsai, Koshi Kumagai |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Myotomy
Adult Male medicine.medical_specialty Adolescent medicine.medical_treatment Per-oral endoscopic myotomy Operative Time Achalasia Treatment failure Esophageal Sphincter Lower Body Mass Index Young Adult medicine Odds Ratio Humans Treatment Failure Aged Randomized Controlled Trials as Topic Heller myotomy Aged 80 and over business.industry Gastroenterology Reflux Middle Aged medicine.disease Dysphagia Dilatation Surgery Esophageal Achalasia Treatment Outcome Anesthesia Gastroesophageal Reflux Female Laparoscopy Esophagoscopy medicine.symptom business Deglutition Disorders Laparoscopic Heller Myotomy |
| Zdroj: | Scandinavian journal of gastroenterology. 50(5) |
| ISSN: | 1502-7708 |
| Popis: | Per-oral endoscopic myotomy (POEM) has recently been introduced as a minimal invasive alternative to conventional treatment for achalasia. This study aimed to clarify the feasibility and the short-term clinical efficacy of POEM as compared to laparoscopic Heller myotomy (LHM).Treatment outcomes were prospectively recorded and compared between the procedures in a nonrandomized fashion. Reduction rate (RR) in timed barium esophagogram (TBE) was calculated at 1, 2 and 5 min after barium ingestion as: RR = 1- postoperative barium height/preoperative barium height. Risk factors for treatment failure defined as the proportion of patients with RR0.5 (1 min) and gastroesophageal reflux (GER) after POEM were analyzed.Forty-two consecutive patients who underwent POEM were compared to 41 patients who had a LHM during the immediate time period prior to the introduction of POEM. Ninety percent of the cases reported complete symptom relief after POEM. The percentage of esophageal emptying and RR in TBE improved dramatically by both procedures without significant difference. A longer operation time (odds ratio [OR] 32.80, 95%CI 2.99-359.82, p = 0.004) and younger age (OR 26.81, 95%CI 2.09-344.03, p = 0.012) were the independent predictors of treatment failure after POEM. GER was observed in seven patients where previous dilatation (OR 8.59, 95%CI 1.16-63.45, p = 0.035) and higher body mass index (OR 8.69, 95%CI 1.13-66.63, p = 0.037) were the independent predictors for symptomatic GER after POEM.POEM seems to be a safe and effective treatment option for achalasia in the short-term perspective; an effect well comparable to LHM. |
| Databáze: | OpenAIRE |
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