A utility of peroral endoscopic myotomy (POEM) across the spectrum of esophageal motility disorders
Autor: | Amit Shetty, Shyam Thakkar, Abhijit Kulkarni, Yoshihiro Komatsu, Rodney J. Landreneau, Emily J. Lloyd, Sara Bloomer, Steve Choe, Toshitaka Hoppo, Blair A. Jobe, Lana Y. Schumacher, Ali H. Zaidi, Mathew A. VanDeusen |
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Rok vydání: | 2015 |
Předmět: |
Adult
Male Natural Orifice Endoscopic Surgery Myotomy medicine.medical_specialty medicine.medical_treatment Achalasia Young Adult 03 medical and health sciences 0302 clinical medicine medicine Humans Favorable outcome Aged Retrospective Studies Aged 80 and over Mucous Membrane business.industry General surgery Middle Aged medicine.disease Dysphagia Endoscopic Procedure Surgery Esophageal Achalasia Cross-Sectional Studies Esophageal motility disorder 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology Esophagoscopy medicine.symptom business |
Zdroj: | Surgical Endoscopy. 30:233-244 |
ISSN: | 1432-2218 0930-2794 |
Popis: | Peroral endoscopic myotomy (POEM) has been performed as a novel endoscopic procedure to treat achalasia with favorable outcome. The objective of this study was to assess the outcome of POEM in our initial series and to assess the safety and efficacy of POEM in a variety of esophageal motility-related clinical problems.This is a retrospective cross-sectional study involving all patients with esophageal motility disorders defined by the Chicago classification, who had undergone consideration for POEM at our institution. Validated questionnaires such as gastroesophageal reflux disease health-related quality of life (GERD-HRQL), reflux symptom index (RSI) and achalasia disease-specific health-related quality of life were obtained pre- and postoperatively.From January 2013 to October 2014, a total of 35 POEMs (achalasia n = 25, non-achalasia n = 10) were performed on 33 patients (female n = 20, male n = 13, mean age 56.9 years). There was no mortality. The rate of inadvertent mucosotomy was 17.1%. The rate of complications requiring interventions was 5.7%. During a mean follow-up period of 7 months (range 0.5-17), 92% of patients with achalasia and 75% of those with non-achalasia motility disorders had a symptomatic improvement in dysphagia. Chest pain was completely resolved in all patients with achalasia (8/8) and 80% of patients with non-achalasia (4/5). The GERD-HRQL, RSI and dysphagia scores significantly improved after POEM in patients with achalasia. There was a significant improvement in GERD-HRQL and RSI scores, and a trend toward lower dysphagia score in patients with non-achalasia.The outcome of POEM to treat achalasia and non-achalasia motility disorders is consistent with previous studies. Potential benefit of POEM includes not only its flexibility to adjust the length and location of myotomy but also the ability to extend myotomy proximally without thoracoscopy or thoracotomy. POEM can be combined with laparoscopic procedures and used as "salvage" for localized esophageal dysmotility. |
Databáze: | OpenAIRE |
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