Comparison of the safety and efficacy of peroral endoscopic myotomy between octogenarians and non‐octogenarians

Abe, Hirofumi; Tanaka, Shinwa; Kawara, Fumiaki; Toyonaga, Takashi; Ariyoshi, Ryusuke; Sakaguchi, Hiroya; Sako, Tomoya; Ikezawa, Nobuaki; Kodama, Yuzo

doi:10.1111/den.13686

Cited by 8 publications

(12 citation statements)

References 19 publications

(44 reference statements)

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“…Our octogenarian group had demographic characteristics similar to other authors that have studied and treated octogenarian patients with achalasia 29 30 31 , with some slight normal differences between populations, but without affecting the results of our study.…”

Section: Discussionsupporting

confidence: 56%

“…POEM and LHM represent the cornerstone of treatment in young patients. POEM has a clinical success in octogenarians of > 90 %, but AE ranging from 5–7.8 %, most of them mild, but up to 10.7 % could be severe 7 29 30 31 . LHM has been associated with perioperative complications (bleeding [5–18 %], perforation [2 %–5 %], postsurgical infection [3 %–6 %]) 8 9 32 33 .…”

Section: Discussionmentioning

confidence: 99%

“…POEM is a safe and effective technique with clinical success of 85 % to 100 % at early and mid-term evaluations, but is risky in octogenarians. Abe et al 30 retrospectively compared the feasibility of POEM in a group of octogenarian vs non-octogenarian patients. Octogenarians had a 100 % clinical success at 1 year, but higher incidence of perioperative AE (28.6 % vs 10.2 %; P < 0.0001), of whom 25 % were major (these included: prolonged ICU stay, bleeding/hepatoma requiring blood transfusion, surgery, leak, cardiac arrhythmia and respiratory issues).…”

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia

et al. 2021

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Backgrounds and study aims Treatment of octogenarian patients with achalasia with conventional treatments is effective but with compromised safety. Biodegradable stents (BS) are promising. We aimed to evaluate their safety, efficacy and clinical outcomes at early, mid and long-term in this population. Patients and methods Naïve or previously-treated achalasic octogenarian patients underwent to BS placement (BSP) between December, 2010 and November, 2011, and were followed-up for 9-years. A strict follow-up was performed. Results Thirty-two patients were included, (17 men [53.1 %]; median age 82 years [78–92]). BSP was performed in all patients. At 9y, 18/32 (56.2 %) completed protocol. Mean BSP time was 37.5±12.1 min and 34.4 % presented thoracic pain. At 1 m, six BS were migrated (18.7 %), requiring a second BSP fixed with hemoclips. At 3 m, twenty-three (72.8 %) completed degradation process. At 6 m, eighteen (56.2 %) presented clinical dysphagia, of whom 5/32 (15.6 %) presented stenotic-tissue hyperplasia, responding to balloon dilation in all cases. Pre-BSP Eckardt, Timed barium esophagram and integrated relaxation pressure improved post-BSP 6 m values (9 vs 2, p = 0.001; < 50 % = 93.8 % vs > 80 % = 81.5 %, p = 0.003 and 18.8 ± 3.2 vs 11.1 ± 2.6 mmHg, p = 0.001, respectively), and there were no significant changes up to 9y post-BSP. Esophagitis grade A or B was presented between 4.7 % to 11.2 % and controlled with PPI. After 9 years we had clinical success rates of 94.4 %, 72 %, and 65.4 % for time point evaluation, per protocol and intention to treat analysis, respectively. Conclusions BSP represents a feasible alternative option in octogenarian patients with achalasia who are high risk with other treatments, presenting acceptable early, mid-, and long-term outcomes.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia

et al. 2021

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“…▶ 4 (2-6) arian patients with achalasia [29][30][31], with some slight normal differences between populations, but without affecting the results of our study. Biodegradable stent placement had a technical success of 100 %, with a mean placement duration of 37.5 ± 12.1 minutes, which is similar to reports using BS in other gastrointestinal diseases (42.1 ± 14 minutes) [18,19,22].…”

Section: Discussionmentioning

confidence: 41%

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2021

Endosc Int Open

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Esophageal achalasia is a primary esophageal motor disorder characterized by aperistalsis and failure in lower esophageal sphincter (LES) relaxation [1]. Treatment aim is to decrease LES pressure and integrated relaxation pressure (IRP), in order to improve symptoms and quality of life [2,3]. Laparoscopic Heller Myotomy (LHM) and Peroral endoscopic myotomy (POEM) are considered the gold standard of treatment [4][5][6]; however, safety is compromised in some populations, such as in elderly patients (adverse events of 2 % to 11.5 % in LHM and 5 % to 7.8 % for POEM [7][8][9]), representing high-risk procedures for them. Alternative treatments include pneumatic dilation (PD) (73 %-88 % early and mid-term efficacy, but a median of 1.9 % perforation rate [4][5][6][7][8][9][10]) and botulinum toxin injection (BTI) (initial 87 % to 92 %, but 22 % to 31 % mid-term efficacy Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia

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“…al demonstrated that POEM carries 93.4 % technical success and 90.8 % clinical success in 76 octogenarians with achalasia with 14.5 % AE rate, all mild to moderate in severity 4 . Octogenarians, compared to younger peers, experience higher incidence of perioperative AEs 4 18 . Thus, in an aging population, exploring supplementary treatment options seems logical- if not necessary 19 .…”

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confidence: 99%