Assessment of Pneumatic Balloon Dilation in Patients with Symptomatic Relapse after Failed Heller Myotomy: A Single Center Experience

Amani, Mohammad; Fazlollahi, Narges; Shirani, Shapour; Malekzadeh, Reza; Mikaeli, Javad

doi:10.15171/mejdd.2016.08

Cited by 21 publications

(14 citation statements)

References 16 publications

(16 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recently, Amani et al . reported a 70% response rate for patients with recurrent symptoms post‐HM . However, previous studies have found more variable and dismal efficacy rates ranging from 9% (1 of 11 patients) to 23% (5 of 22 patients) .…”

Section: Discussionmentioning

confidence: 93%

Peroral endoscopic myotomy as salvation technique post‐Heller: International experience

Tyberg

Sharaiha

Familiari

et al. 2017

Digestive Endoscopy

View full text Add to dashboard Cite

Background Treatment for achalasia has traditionally been Heller myotomy (HM). Despite its excellent efficacy rate, a number of patients remain symptomatic post‐procedure. Limited data exist as to the best management for recurrence of symptoms post‐HM. We present an international, multicenter experience evaluating the efficacy and safety of post‐HM peroral endoscopic myotomy (POEM). Methods Patients who underwent POEM post‐HM from 13 centers from January 2012 to January 2017 were included as part of a prospective registry. Technical success was defined as successful completion of the myotomy. Clinical success was defined as an Eckardt score of ≤3 on 12‐month follow up. Adverse events (AE) including anesthesia‐related, operative, and postoperative complications were recorded. Results Fifty‐one patients were included in the study (mean age 54.2, 47% male). Technical success was achieved in 100% of patients. Clinical success on long‐term follow up was achieved in 48 patients (94%), with a mean change in Eckardt score of 6.25. Seven patients (13%) had AE: six experienced periprocedural mucosal defect treated endoscopically and two patients developed mediastinitis treated conservatively. Conclusion For patients with persistent symptoms after HM, POEM is a safe salvation technique with good short‐term efficacy. As a result of the challenge associated with repeat HM, POEM might become the preferred technique in this patient population. Further studies with longer follow up are needed.

show abstract

Section: Discussionmentioning

confidence: 93%

Peroral endoscopic myotomy as salvation technique post‐Heller: International experience

Tyberg

Sharaiha

Familiari

et al. 2017

Digestive Endoscopy

View full text Add to dashboard Cite

show abstract

“…Of the 87 patients treated with PD,[ 8 9 10 11 ] only the cause of failure was defined in one study. Of 113 patients in this study, the presence of an incomplete myotomy combined with fibrosis was identified in seven patients as the cause of myotomy failure, and in one patient, the origin of the failure was incomplete myotomy without fibrosis.…”

Section: Resultsmentioning

confidence: 99%

What to do when Heller's myotomy fails? Pneumatic dilatation, laparoscopic remyotomy or peroral endoscopic myotomy: A systematic review

et al. 2018

View full text Add to dashboard Cite

Background:Surgical treatment of achalasia fails in 10%–20% of patients. The most frequent responsible cause is the performance of an incomplete myotomy at primary surgery. The treatment when the failure happens is not well defined. In this study, we review and evaluate the possible treatments to be carried out when surgical myotomy fails. We define its benefits and results, with the purpose of defining a therapeutic algorithm.Materials and Methods:The systematic review was performed following the guidelines established by the Meta-analysis of Observational Studies in Epidemiology statement. We searched several electronic databases (MEDLINE, PubMED, EMBASE and Cochrane) from January 1991 to March 2017, with the keywords 'recurrent achalasia' 'POEM remyotomy', 'esophagomyotomy failure', 'Heller myotomy failure', 'myotomy failure', 'pneumatic balloon dilatation achalasia' and combinations between them, 'redo Heller', 'redo myotomy', 'reoperative Heller'.Results:A total of 61 observational studies related to the treatment of patients with failure of Heller's myotomy were initially found. Finally, 37 articles were included in our study that provided data on 289 patients. Of these 289 patients, diagnosed of failed Heller's myotomy, 87 were treated with pneumatic dilatation (PD), 166 underwent surgical revision and finally 36 were treated with POEM. No randomised controlled trial was identified.Conclusions:The three therapeutic options analysed in this review are effective and safe in the treatment of patients with achalasia with failure of surgical myotomy. The best results can be achieved following an algorithm similar to the one proposed here, where each procedure must be performed by well-experienced team in the selected modality.

show abstract

“…When no gross anatomic abnormalities are present, PD or POEM can be considered. Both procedures show equally modest efficacy rates, but PD is often regarded a less invasive first step 71–79 . In the event of recurrence due to a too tight or twisted fundoplication, or a more complex anatomy with oesophageal distortion, fibrosis or a post‐myotomy diverticulum, redo surgery may be considered.…”

Section: Achalasia Treatmentmentioning

confidence: 99%

European guidelines on achalasia: United European Gastroenterology and European Society of Neurogastroenterology and Motility recommendations

et al. 2020

View full text Add to dashboard Cite

Introduction Achalasia is a primary motor disorder of the oesophagus characterised by absence of peristalsis and insufficient lower oesophageal sphincter relaxation. With new advances and developments in achalasia management, there is an increasing demand for comprehensive evidence-based guidelines to assist clinicians in achalasia patient care. Methods Guidelines were established by a working group of representatives from United European Gastroenterology, European Society of Neurogastroenterology and Motility, European Society of Gastrointestinal and Abdominal Radiology and the European Association of Endoscopic Surgery in accordance with the Appraisal of Guidelines for Research and Evaluation II instrument. A systematic review of the literature was performed, and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Recommendations were voted upon using a nominal group technique. Results These guidelines focus on the definition of achalasia, treatment aims, diagnostic tests, medical, endoscopic and surgical therapy, management of treatment failure, follow-up and oesophageal cancer risk. Conclusion These multidisciplinary guidelines provide a comprehensive evidence-based framework with recommendations on the diagnosis, treatment and follow-up of adult achalasia patients.

show abstract

Assessment of Pneumatic Balloon Dilation in Patients with Symptomatic Relapse after Failed Heller Myotomy: A Single Center Experience

Cited by 21 publications

References 16 publications

Peroral endoscopic myotomy as salvation technique post‐Heller: International experience

Peroral endoscopic myotomy as salvation technique post‐Heller: International experience

What to do when Heller's myotomy fails? Pneumatic dilatation, laparoscopic remyotomy or peroral endoscopic myotomy: A systematic review

European guidelines on achalasia: United European Gastroenterology and European Society of Neurogastroenterology and Motility recommendations

Contact Info

Product

Resources

About