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Obesity Does Not Impact Outcomes or Rates of Gastroesophageal Reflux After Peroral Endoscopic Myotomy in Achalasia.
J Clin Gastroenterol. 2020 Apr; 54(4):338-343.JC

Abstract

BACKGROUND

Outcomes of laparoscopic Heller myotomy in obese patients with achalasia are suboptimal along with the increased risk of gastroesophageal reflux disease (GERD). The impact of obesity on treatment success and GERD after peroral endoscopic myotomy (POEM) are not well known. Hence, our study aims were to compare the clinical outcomes and rates of GERD after POEM in nonobese versus obese patients with achalasia.

METHODS

Chart review of all achalasia patients who underwent POEM at our institution between April 2014 and June 2018. Patients with timed barium esophagram (TBE) and high-resolution esophageal manometry (HREM) before POEM along with post-POEM TBE, HREM, and esophageal pH study were included. Patients were categorized into 2 groups, nonobese (body mass index <30 kg/m) and obese (body mass index ≥30 kg/m). Patient demographics, TBE, HREM, pH study findings, and Eckardt scores were compared between the 2 groups.

RESULTS

A total of 89 patients (46 nonobese; 43 obese) met the study criteria. There were no significant differences in age, gender, achalasia subtype, operative time, length of stay and complication rates between the 2 groups. Treatment success (Eckardt score ≤3) was similar in both groups (97.7% nonobese vs. 92.7% obese, P=0.35). Abnormal DeMeester scores on pH study (>14.72) were similar in nonobese and obese patients (58.7% vs. 46.5%, P=0.25). Symptomatic GERD was also similar in both groups (17.8% in nonobese vs. 20% in obese, P=0.79).

CONCLUSIONS

POEM is an equally safe and effective treatment option for both nonobese and obese patients with achalasia in the short-term. Interestingly, POEM does not lead to higher rates of GERD in obese compared with nonobese patients.

Authors+Show Affiliations

Departments of Gastroenterology and Hepatology.Departments of Gastroenterology and Hepatology.Departments of Gastroenterology and Hepatology.Departments of Gastroenterology and Hepatology.Departments of Gastroenterology and Hepatology.Quantitative Health Sciences.Departments of Gastroenterology and Hepatology.Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH.Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31306345

Citation

Sanaka, Madhusudhan R., et al. "Obesity Does Not Impact Outcomes or Rates of Gastroesophageal Reflux After Peroral Endoscopic Myotomy in Achalasia." Journal of Clinical Gastroenterology, vol. 54, no. 4, 2020, pp. 338-343.
Sanaka MR, Parikh MP, Subramanium S, et al. Obesity Does Not Impact Outcomes or Rates of Gastroesophageal Reflux After Peroral Endoscopic Myotomy in Achalasia. J Clin Gastroenterol. 2020;54(4):338-343.
Sanaka, M. R., Parikh, M. P., Subramanium, S., Thota, P. N., Gupta, N. M., Lopez, R., Gabbard, S., Murthy, S., & Raja, S. (2020). Obesity Does Not Impact Outcomes or Rates of Gastroesophageal Reflux After Peroral Endoscopic Myotomy in Achalasia. Journal of Clinical Gastroenterology, 54(4), 338-343. https://doi.org/10.1097/MCG.0000000000001235
Sanaka MR, et al. Obesity Does Not Impact Outcomes or Rates of Gastroesophageal Reflux After Peroral Endoscopic Myotomy in Achalasia. J Clin Gastroenterol. 2020;54(4):338-343. PubMed PMID: 31306345.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Obesity Does Not Impact Outcomes or Rates of Gastroesophageal Reflux After Peroral Endoscopic Myotomy in Achalasia. AU - Sanaka,Madhusudhan R, AU - Parikh,Malav P, AU - Subramanium,Subanandhini, AU - Thota,Prashanthi N, AU - Gupta,Niyati M, AU - Lopez,Rocio, AU - Gabbard,Scott, AU - Murthy,Sudish, AU - Raja,Siva, PY - 2019/7/16/pubmed PY - 2019/7/16/medline PY - 2019/7/16/entrez SP - 338 EP - 343 JF - Journal of clinical gastroenterology JO - J. Clin. Gastroenterol. VL - 54 IS - 4 N2 - BACKGROUND: Outcomes of laparoscopic Heller myotomy in obese patients with achalasia are suboptimal along with the increased risk of gastroesophageal reflux disease (GERD). The impact of obesity on treatment success and GERD after peroral endoscopic myotomy (POEM) are not well known. Hence, our study aims were to compare the clinical outcomes and rates of GERD after POEM in nonobese versus obese patients with achalasia. METHODS: Chart review of all achalasia patients who underwent POEM at our institution between April 2014 and June 2018. Patients with timed barium esophagram (TBE) and high-resolution esophageal manometry (HREM) before POEM along with post-POEM TBE, HREM, and esophageal pH study were included. Patients were categorized into 2 groups, nonobese (body mass index <30 kg/m) and obese (body mass index ≥30 kg/m). Patient demographics, TBE, HREM, pH study findings, and Eckardt scores were compared between the 2 groups. RESULTS: A total of 89 patients (46 nonobese; 43 obese) met the study criteria. There were no significant differences in age, gender, achalasia subtype, operative time, length of stay and complication rates between the 2 groups. Treatment success (Eckardt score ≤3) was similar in both groups (97.7% nonobese vs. 92.7% obese, P=0.35). Abnormal DeMeester scores on pH study (>14.72) were similar in nonobese and obese patients (58.7% vs. 46.5%, P=0.25). Symptomatic GERD was also similar in both groups (17.8% in nonobese vs. 20% in obese, P=0.79). CONCLUSIONS: POEM is an equally safe and effective treatment option for both nonobese and obese patients with achalasia in the short-term. Interestingly, POEM does not lead to higher rates of GERD in obese compared with nonobese patients. SN - 1539-2031 UR - https://www.unboundmedicine.com/medline/citation/31306345/Obesity_Does_Not_Impact_Outcomes_or_Rates_of_Gastroesophageal_Reflux_After_Peroral_Endoscopic_Myotomy_in_Achalasia_ L2 - https://doi.org/10.1097/MCG.0000000000001235 DB - PRIME DP - Unbound Medicine ER -