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Peroral endoscopic myotomy is a safe and effective treatment modality for geriatric patients with achalasia.
Esophagus. 2020 Oct; 17(4):484-491.E

Abstract

BACKGROUND

Peroral endoscopic myotomy (POEM) is an appealing treatment for older patients, as it is minimally invasive but highly efficacious similar to surgical myotomy. However, there is a lack of systematic studies analyzing POEM outcomes in young (< 65 years) versus geriatric patients (≥ 65 years). Hence, we aimed to compare the safety and efficacy of POEM in young versus geriatric patients.

METHODS

Records of all achalasia patients who underwent POEM at our institution between April 2014 and May 2019 were reviewed. Patients were categorized into two groups: young (< 65 years) and old (≥ 65 years). Demographic and procedural details, timed barium esophagram (TBE), high-resolution manometry (HREM), pH study findings and Eckardt scores were compared between the two groups. Post-POEM Eckhardt score of ≤ 3 was defined as treatment success.

RESULTS

A total of 148 patients met the study criteria (young = 93; old = 55). Younger patients were more likely to have lower TBE height at 1 min but wider TBE width at 5 min. The rest of the pre-operative parameters and Eckardt scores were similar in the two groups. Young patients were more likely to have undergone prior Heller myotomy, while Botox injections were common in the older group. The operative details and outcomes were similar in the two groups. Treatment success rates were similar in both groups (94.9% young vs. 94.7% in old patients, p = 1.00). At 2-month follow-up, both groups showed significant improvements in Eckhardt scores and HREM parameters; however, older patients showed greater improvement in TBE height at 1 and 5 min. The rates of symptomatic GERD and abnormal esophageal pH study findings were similar in the two groups.

CONCLUSION

POEM was safe and highly effective treatment for geriatric patients with achalasia. These findings suggest that POEM might emerge as the preferred approach for myotomy in this patient population.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Desk Q3, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA. sanakam@ccf.org.Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Desk Q3, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA.Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Desk Q3, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA.Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Desk Q3, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA.Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Desk Q3, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA.Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Desk Q3, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA.Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32394115

Citation

Sanaka, Madhusudhan R., et al. "Peroral Endoscopic Myotomy Is a Safe and Effective Treatment Modality for Geriatric Patients With Achalasia." Esophagus : Official Journal of the Japan Esophageal Society, vol. 17, no. 4, 2020, pp. 484-491.
Sanaka MR, Chadalavada P, Alomari M, et al. Peroral endoscopic myotomy is a safe and effective treatment modality for geriatric patients with achalasia. Esophagus. 2020;17(4):484-491.
Sanaka, M. R., Chadalavada, P., Alomari, M., Tang, A., Parikh, M., Garg, R., Gupta, N., Thota, P., Gabbard, S., Murthy, S., & Raja, S. (2020). Peroral endoscopic myotomy is a safe and effective treatment modality for geriatric patients with achalasia. Esophagus : Official Journal of the Japan Esophageal Society, 17(4), 484-491. https://doi.org/10.1007/s10388-020-00746-5
Sanaka MR, et al. Peroral Endoscopic Myotomy Is a Safe and Effective Treatment Modality for Geriatric Patients With Achalasia. Esophagus. 2020;17(4):484-491. PubMed PMID: 32394115.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Peroral endoscopic myotomy is a safe and effective treatment modality for geriatric patients with achalasia. AU - Sanaka,Madhusudhan R, AU - Chadalavada,Pravallika, AU - Alomari,Mohammad, AU - Tang,Andrew, AU - Parikh,Malav, AU - Garg,Rajat, AU - Gupta,Niyathi, AU - Thota,Prashanthi, AU - Gabbard,Scott, AU - Murthy,Sudish, AU - Raja,Siva, Y1 - 2020/05/11/ PY - 2020/01/16/received PY - 2020/04/26/accepted PY - 2020/5/13/pubmed PY - 2020/5/13/medline PY - 2020/5/13/entrez KW - Achalasia KW - Geriatric patients KW - Myotomy KW - Peroral endoscopic myotomy (POEM) KW - Safety and outcomes SP - 484 EP - 491 JF - Esophagus : official journal of the Japan Esophageal Society JO - Esophagus VL - 17 IS - 4 N2 - BACKGROUND: Peroral endoscopic myotomy (POEM) is an appealing treatment for older patients, as it is minimally invasive but highly efficacious similar to surgical myotomy. However, there is a lack of systematic studies analyzing POEM outcomes in young (< 65 years) versus geriatric patients (≥ 65 years). Hence, we aimed to compare the safety and efficacy of POEM in young versus geriatric patients. METHODS: Records of all achalasia patients who underwent POEM at our institution between April 2014 and May 2019 were reviewed. Patients were categorized into two groups: young (< 65 years) and old (≥ 65 years). Demographic and procedural details, timed barium esophagram (TBE), high-resolution manometry (HREM), pH study findings and Eckardt scores were compared between the two groups. Post-POEM Eckhardt score of ≤ 3 was defined as treatment success. RESULTS: A total of 148 patients met the study criteria (young = 93; old = 55). Younger patients were more likely to have lower TBE height at 1 min but wider TBE width at 5 min. The rest of the pre-operative parameters and Eckardt scores were similar in the two groups. Young patients were more likely to have undergone prior Heller myotomy, while Botox injections were common in the older group. The operative details and outcomes were similar in the two groups. Treatment success rates were similar in both groups (94.9% young vs. 94.7% in old patients, p = 1.00). At 2-month follow-up, both groups showed significant improvements in Eckhardt scores and HREM parameters; however, older patients showed greater improvement in TBE height at 1 and 5 min. The rates of symptomatic GERD and abnormal esophageal pH study findings were similar in the two groups. CONCLUSION: POEM was safe and highly effective treatment for geriatric patients with achalasia. These findings suggest that POEM might emerge as the preferred approach for myotomy in this patient population. SN - 1612-9067 UR - https://www.unboundmedicine.com/medline/citation/32394115/Peroral_endoscopic_myotomy_is_a_safe_and_effective_treatment_modality_for_geriatric_patients_with_achalasia_ L2 - https://antibodies.cancer.gov/detail/CPTC-MET-1 DB - PRIME DP - Unbound Medicine ER -
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