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Peroral Endoscopic Myotomy Is Safe and Highly Effective Treatment for Advanced Achalasia With Sigmoid Esophagus.
J Clin Gastroenterol. 2020 Jul 08 [Online ahead of print]JC

Abstract

BACKGROUND AND AIMS

In advanced achalasia patients with sigmoid esophagus, peroral endoscopic myotomy (POEM) might be technically challenging and its outcomes are not well known in western population. Hence, our study aims were to assess and compare the safety and efficacy of POEM in achalasia patients with and without sigmoid esophagus.

MATERIALS AND METHODS

Medical records of achalasia patients who had POEM at our institution between April 2014 and December 2019 were reviewed. Patients who underwent work-up comprising timed barium esophagram (TBE) and high-resolution esophageal manometry (HREM) before POEM along with 2-month post-POEM esophageal pH study, TBE and HREM were included in the final analysis. Patients were categorized as either sigmoid or no sigmoid esophagus based on the morphology of esophagus on TBE as per Japan Esophageal Society guidelines. Treatment success was defined as reduction of post-POEM Eckardt score to ≤3.

RESULTS

A total of 168 patients (sigmoid esophagus=20; no sigmoid esophagus=148) were included. Esophageal width on TBE at 1 minute was significantly higher in sigmoid esophagus group compared with no sigmoid esophagus group (4.9 vs. 3.0 cm, P<0.001). Procedural outcomes and complications were similar in both groups. At 2-month follow-up, both groups had significant improvement in Eckardt scores, TBE, and HREM parameters. Treatment success was high and similar in both sigmoid and no sigmoid groups (94.4% vs. 93.2%, P=0.84). The rates of gastroesophageal reflux disease were also similar in both groups.

CONCLUSIONS

Our study findings suggest that POEM is safe and highly effective treatment for achalasia patients with sigmoid esophagus similar to those without sigmoid esophagus in western population. POEM should be considered as the treatment of choice in advanced achalasia with sigmoid esophagus.

Authors+Show Affiliations

Departments of Gastroenterology and Hepatology.Internal Medicine.Internal Medicine.Departments of Gastroenterology and Hepatology.Departments of Gastroenterology and Hepatology.Internal Medicine.Internal Medicine.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

32649445

Citation

Sanaka, Madhusudhan R., et al. "Peroral Endoscopic Myotomy Is Safe and Highly Effective Treatment for Advanced Achalasia With Sigmoid Esophagus." Journal of Clinical Gastroenterology, 2020.
Sanaka MR, Garg R, Chadalavada P, et al. Peroral Endoscopic Myotomy Is Safe and Highly Effective Treatment for Advanced Achalasia With Sigmoid Esophagus. J Clin Gastroenterol. 2020.
Sanaka, M. R., Garg, R., Chadalavada, P., Thota, P. N., Gabbard, S., Parikh, M. P., Khoudari, G., Murthy, S., & Raja, S. (2020). Peroral Endoscopic Myotomy Is Safe and Highly Effective Treatment for Advanced Achalasia With Sigmoid Esophagus. Journal of Clinical Gastroenterology. https://doi.org/10.1097/MCG.0000000000001388
Sanaka MR, et al. Peroral Endoscopic Myotomy Is Safe and Highly Effective Treatment for Advanced Achalasia With Sigmoid Esophagus. J Clin Gastroenterol. 2020 Jul 8; PubMed PMID: 32649445.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Peroral Endoscopic Myotomy Is Safe and Highly Effective Treatment for Advanced Achalasia With Sigmoid Esophagus. AU - Sanaka,Madhusudhan R, AU - Garg,Rajat, AU - Chadalavada,Pravallika, AU - Thota,Prashanthi N, AU - Gabbard,Scott, AU - Parikh,Malav P, AU - Khoudari,George, AU - Murthy,Sudish, AU - Raja,Siva, Y1 - 2020/07/08/ PY - 2020/7/11/entrez PY - 2020/7/11/pubmed PY - 2020/7/11/medline JF - Journal of clinical gastroenterology JO - J. Clin. Gastroenterol. N2 - BACKGROUND AND AIMS: In advanced achalasia patients with sigmoid esophagus, peroral endoscopic myotomy (POEM) might be technically challenging and its outcomes are not well known in western population. Hence, our study aims were to assess and compare the safety and efficacy of POEM in achalasia patients with and without sigmoid esophagus. MATERIALS AND METHODS: Medical records of achalasia patients who had POEM at our institution between April 2014 and December 2019 were reviewed. Patients who underwent work-up comprising timed barium esophagram (TBE) and high-resolution esophageal manometry (HREM) before POEM along with 2-month post-POEM esophageal pH study, TBE and HREM were included in the final analysis. Patients were categorized as either sigmoid or no sigmoid esophagus based on the morphology of esophagus on TBE as per Japan Esophageal Society guidelines. Treatment success was defined as reduction of post-POEM Eckardt score to ≤3. RESULTS: A total of 168 patients (sigmoid esophagus=20; no sigmoid esophagus=148) were included. Esophageal width on TBE at 1 minute was significantly higher in sigmoid esophagus group compared with no sigmoid esophagus group (4.9 vs. 3.0 cm, P<0.001). Procedural outcomes and complications were similar in both groups. At 2-month follow-up, both groups had significant improvement in Eckardt scores, TBE, and HREM parameters. Treatment success was high and similar in both sigmoid and no sigmoid groups (94.4% vs. 93.2%, P=0.84). The rates of gastroesophageal reflux disease were also similar in both groups. CONCLUSIONS: Our study findings suggest that POEM is safe and highly effective treatment for achalasia patients with sigmoid esophagus similar to those without sigmoid esophagus in western population. POEM should be considered as the treatment of choice in advanced achalasia with sigmoid esophagus. SN - 1539-2031 UR - https://www.unboundmedicine.com/medline/citation/32649445/Peroral_Endoscopic_Myotomy_Is_Safe_and_Highly_Effective_Treatment_for_Advanced_Achalasia_With_Sigmoid_Esophagus L2 - https://doi.org/10.1097/MCG.0000000000001388 DB - PRIME DP - Unbound Medicine ER -