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Surgical Endoscopy

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01-03-2016

Function of high-resolution manometry in the analysis of peroral endoscopic myotomy for achalasia

Authors: Hui Ju, Yongfen Ma, Kun Liang, Cuiping Zhang, Zibin Tian

Published in: Surgical Endoscopy | Issue 3/2016

Abstract

Background

Peroral endoscopic myotomy (POEM) was introduced as a new effective therapeutic option for esophageal achalasia.

Method

A total of 112 achalasia patients categorized into three subtypes by HRM who underwent POEM were enrolled in our study. Eckardt score and HRM were performed preoperation, 6 months, and 1 year after POEM to evaluate the effectiveness, safety, and feasibility of POEM and to investigate the treatment response to POEM for the three subtypes of achalasia, classified by high-resolution manometry (HRM).

Results

POEM was successfully performed in all patients. Compared with pre-POEM scores, the Eckardt scores were significantly reduced from 7.3 ± 1.4 to 1.0 ± 0.8 6 months after POEM and to 1.2 ± 0.6 1 year after POEM (p < 0.05). The LESP before treatment was 41.8 ± 15.3 mmHg, compared with a LESP of 18.4 ± 7.1 mmHg 6 months after POEM and 20.7 ± 7.5 mmHg 1 year after POEM (p < 0.05). In addition, POEM decreased the 4-s IRP from 33.4 ± 9.0 to 14.6 ± 3.8 mmHg 6 months after POEM and to 16.4 ± 3.9 mmHg 1 year after POEM (p < 0.05). The 4-s IRP was reduced to <15 mmHg in 64 of 112 patients. Type II had the best response to POEM, while type III exhibited the worst response.

Conclusions

POEM appears to be an effective and less invasive treatment for achalasia. HRM can be useful in the classification of achalasia, while these subclassifications help to predict the responsiveness to POEM.

Podas T, Eaden J, Mayberry M, Mayberry J (1998) Achalasia: a critical review of epidemiological studies. Am J Gastroenterol 93:2345–2347CrossRefPubMed

Cheng YS, Li MH, Chen WX, Chen NW, Zhuang QX, Shang KZ (2003) Selection and evaluation of three interventional procedures for achalasia based on long-term follow-up. World J Gastroenterol 9:2370–2373PubMedCentralCrossRefPubMed

Tsiaoussis J, Athanasakis E, Pechlivanides G, Tzortzinis A, Gouvas N, Mantides A et al (2007) Long-term functional results after laparoscopic surgery for esophageal achalasia. Am J Surg 193:26–31CrossRefPubMed

Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M et al (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271CrossRefPubMed

Eckardt VF (2001) Clinical presentations and complications of achalasia. Gastrointest Endosc Clin N Am 11:281–292PubMed

Jones R, Junghard O, Dent J, Vakil N, Halling K, Wernersson B et al (2009) Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther 30:1030–1038CrossRefPubMed

Allaix ME, Patti MG (2013) New trends and concepts in diagnosis and treatment of achalasia]. Cir Esp 91:352–357CrossRefPubMed

Bredenoord AJ, Hebbard GS (2012) Technical aspects of clinical high-resolution manometry studies. Neurogastroenterol Motil 24(Suppl. 1):5–10CrossRefPubMed

Roman S, Kahrilas PJ, Boris L, Bidari K, Luger D, Pandolfino JE (2011) High-resolution manometry studies are frequently imperfect but usually still interpretable. Clin Gastroenterol Hepatol 9:1050–1055PubMedCentralCrossRefPubMed

10.

Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ (2008) Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 135:1526–1533PubMedCentralCrossRefPubMed

11.

Eleftheriadis N, Inoue H, Ikeda H, Onimaru M, Yoshida A, Hosoya T et al (2012) Training in peroral endoscopic myotomy (POEM) for esophageal achalasia. Ther Clin Risk Manag 8:329–342PubMedCentralCrossRefPubMed

12.

Beck WC, Sharp KW (2011) Achalasia. Surg Clin North Am 91:1031–1037CrossRefPubMed

13.

Vaezi MF, Pandolfino JE, Vela MF (2013) ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol 108:1238–1249 quiz 50 CrossRefPubMed

14.

Patti MG, Arcerito M, De Pinto M, Feo CV, Tong J, Gantert W et al (1998) Comparison of thoracoscopic and laparoscopic Heller myotomy for achalasia. J Gastrointest Surg 2:561–566CrossRefPubMed

15.

Allaix ME, Patti MG (2013) What is the best primary therapy for achalasia: medical or surgical treatment? Who owns achalasia? J Gastrointest Surg 17:1547–1549CrossRefPubMed

16.

Boeckxstaens G, Zaninotto G (2012) Achalasia and esophago-gastric junction outflow obstruction: focus on the subtypes. Neurogastroenterol Motil 24(Suppl 1):27–31CrossRefPubMed

17.

Pescarus R, Shlomovitz E, Swanstrom LL (2014) Per-oral endoscopic myotomy (POEM) for esophageal achalasia. Current Gastroenterol Rep 16:369CrossRef

18.

Hungness ES, Teitelbaum EN, Santos BF, Arafat FO, Pandolfino JE, Kahrilas PJ et al (2013) Comparison of perioperative outcomes between peroral esophageal myotomy (POEM) and laparoscopic Heller myotomy. J Gastrointest Surg 17:228–235CrossRefPubMed

19.

Swanstrom LL, Kurian A, Dunst CM, Sharata A, Bhayani N, Rieder E (2012) Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg 256:659–667CrossRefPubMed

20.

Kwiatek MA, Pandolfino JE, Hirano I, Kahrilas PJ (2010) Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Gastrointest Endosc 72:272–278PubMedCentralCrossRefPubMed

Title: Function of high-resolution manometry in the analysis of peroral endoscopic myotomy for achalasia
Authors: Hui Ju
Yongfen Ma
Kun Liang
Cuiping Zhang
Zibin Tian
Publication date: 01-03-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 3/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4304-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Function of high-resolution manometry in the analysis of peroral endoscopic myotomy for achalasia

Abstract

Background

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusions

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