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Morphologic Restoration After Peroral Endoscopic Myotomy in Sigmoid-type Achalasia.
J Neurogastroenterol Motil. 2020 Jan 30; 26(1):67-73.JN

Abstract

Background/Aims

Achalasia is a chronic, progressive motility disorder of the esophagus. The sigmoid-type achalasia is an advanced stage of achalasia characterized by severe dilatation and tortuous angulation of the esophageal body. Peroral endoscopic myotomy (POEM) has been reported to provide excellent clinical outcomes for achalasia, including the sigmoid type, but the restoration of esophageal morphology and function remain poorly described. The aim of our study is to investigate esophageal restoration after POEM for sigmoid-type achalasia.

Methods

From 98 patients with achalasia who underwent POEM in the Yonsei University Health System from 2013 to 2018, we recruited 13 patients with sigmoid-type achalasia (7 male; mean age 53.3 years) and assessed morphological and manometric changes in the esophagus.

Results

Clinical success (Eckardt score < 3) was achieved in all cases. After POEM, the average angle of esophageal tortuosity became more obtuse (91.5° vs 114.6°, P = 0.046), esophageal body diameter decreased (67.6 vs 49.8 mm, P = 0.002), and esophagogastric junction opening widened (6.4 vs 9.5 mm, P = 0.048). Patients whose esophageal tortuosity did not improve had longer durations of symptoms than patients with improvement (80.2 vs 636 months, P < 0.001). An absence of peristalsis was observed in all patients pre- and post-POEM.

Conclusions

POEM resulted in excellent clinical outcomes and morphologic improvement in sigmoid-type achalasia. These results suggest that the improvement of esophageal tortuosity through POEM reflects a reduced esophageal burden.

Authors+Show Affiliations

Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31869868

Citation

Yoon, Hong Jin, et al. "Morphologic Restoration After Peroral Endoscopic Myotomy in Sigmoid-type Achalasia." Journal of Neurogastroenterology and Motility, vol. 26, no. 1, 2020, pp. 67-73.
Yoon HJ, Lee JE, Jung DH, et al. Morphologic Restoration After Peroral Endoscopic Myotomy in Sigmoid-type Achalasia. J Neurogastroenterol Motil. 2020;26(1):67-73.
Yoon, H. J., Lee, J. E., Jung, D. H., Park, J. C., Youn, Y. H., & Park, H. (2020). Morphologic Restoration After Peroral Endoscopic Myotomy in Sigmoid-type Achalasia. Journal of Neurogastroenterology and Motility, 26(1), 67-73. https://doi.org/10.5056/jnm19144
Yoon HJ, et al. Morphologic Restoration After Peroral Endoscopic Myotomy in Sigmoid-type Achalasia. J Neurogastroenterol Motil. 2020 Jan 30;26(1):67-73. PubMed PMID: 31869868.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Morphologic Restoration After Peroral Endoscopic Myotomy in Sigmoid-type Achalasia. AU - Yoon,Hong Jin, AU - Lee,Jeung Eun, AU - Jung,Da Hyun, AU - Park,Jun Chul, AU - Youn,Young Hoon, AU - Park,Hyojin, PY - 2019/07/29/received PY - 2019/10/17/revised PY - 2019/11/25/accepted PY - 2019/12/24/pubmed PY - 2019/12/24/medline PY - 2019/12/24/entrez KW - Esophageal achalasia KW - Myotomy KW - Peroral endoscopic myotomy KW - Sigmoid-type achalasia SP - 67 EP - 73 JF - Journal of neurogastroenterology and motility JO - J Neurogastroenterol Motil VL - 26 IS - 1 N2 - Background/Aims: Achalasia is a chronic, progressive motility disorder of the esophagus. The sigmoid-type achalasia is an advanced stage of achalasia characterized by severe dilatation and tortuous angulation of the esophageal body. Peroral endoscopic myotomy (POEM) has been reported to provide excellent clinical outcomes for achalasia, including the sigmoid type, but the restoration of esophageal morphology and function remain poorly described. The aim of our study is to investigate esophageal restoration after POEM for sigmoid-type achalasia. Methods: From 98 patients with achalasia who underwent POEM in the Yonsei University Health System from 2013 to 2018, we recruited 13 patients with sigmoid-type achalasia (7 male; mean age 53.3 years) and assessed morphological and manometric changes in the esophagus. Results: Clinical success (Eckardt score < 3) was achieved in all cases. After POEM, the average angle of esophageal tortuosity became more obtuse (91.5° vs 114.6°, P = 0.046), esophageal body diameter decreased (67.6 vs 49.8 mm, P = 0.002), and esophagogastric junction opening widened (6.4 vs 9.5 mm, P = 0.048). Patients whose esophageal tortuosity did not improve had longer durations of symptoms than patients with improvement (80.2 vs 636 months, P < 0.001). An absence of peristalsis was observed in all patients pre- and post-POEM. Conclusions: POEM resulted in excellent clinical outcomes and morphologic improvement in sigmoid-type achalasia. These results suggest that the improvement of esophageal tortuosity through POEM reflects a reduced esophageal burden. SN - 2093-0879 UR - https://www.unboundmedicine.com/medline/citation/31869868/Morphologic_Restoration_After_Peroral_Endoscopic_Myotomy_in_Sigmoid_type_Achalasia_ L2 - http://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm19144 DB - PRIME DP - Unbound Medicine ER -
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