Development of a preoperative risk-scoring system for predicting poor responders to peroral endoscopic myotomy

Urakami, Satoshi; Abe, Hirofumi; Tanaka, Shinwa; Kawara, Fumiaki; Toyonaga, Takashi; Ariyoshi, Ryusuke; Sako, Tomoya; Ikezawa, Nobuaki; Ueda, Chise; Kodama, Yuzo

doi:10.1016/j.gie.2020.06.028

Cited by 22 publications

(31 citation statements)

References 19 publications

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“…A total of 244 patients undergoing POEM for esophageal motility disorders at a single center were retrospectively included in their study. 34 Poor responders were defined as patients with any of the following at 1-year follow-up: ES ⩾3, endoscopic findings of food retention, and retreatments (endoscopic balloon dilation, re-POEM, and surgical myotomy). All others were deemed good responders.…”

Section: Endoscopic Approachesmentioning

confidence: 99%

Insights into the endoscopic management of esophageal achalasia

Brindise

Khashab

Abiad

2021

Clin Med Insights Gastroenterol

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Achalasia is a primary esophageal motility disorder characterized by the loss of inhibitory neurons in the myenteric plexus, resulting in impaired relaxation of the esophagogastric junction. Achalasia is an incurable disease, and the treatment modalities are aimed at disruption of the esophagogastric junction and vary widely from pharmacological to endoscopic to surgical. Traditional endoscopic therapy includes pneumatic dilation, botulinum toxin injection, and peroral endoscopic myotomy. This review aims to provide an overview of the endoscopic management of achalasia, while focusing on the utilization of peroral endoscopic myotomy and other novel approaches.

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Section: Endoscopic Approachesmentioning

confidence: 99%

Insights into the endoscopic management of esophageal achalasia

Brindise

Khashab

Abiad

2021

Clin Med Insights Gastroenterol

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“…The available data suggests that the probability of clinical failure is higher in those with pretreatment Eckardt score ≥ 9, previous treatment, intraprocedural mucosal injury, reflux, and esophageal dilatation (≥ grade II or ≥ 3.5 cm). [59][60][61] The Eckardt score is a symptom-based score and comprises four distinct symptoms including dysphagia (0-3), regurgitation (0-3), chest pain (0-3) and weight loss (0-3), whereas esophageal dilatation is graded as grade I (< 3.5 cm), grade II (≥ 3.5-6 cm) and grade III (> 6 cm). 60 In two recent studies, risk-scoring systems were devised using these risk factors to predict clinical failure after POEM.…”

Section: Predictors Of Outcomesmentioning

confidence: 99%

Optional Management of Achalasia in 2021: Dilatation or Myotomy

Nabi

Ramchandani

Reddy

2021

Journal of Digestive Endoscopy

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Achalasia cardia is a primary motility disorder of the esophagus, defined by lack of normal esophageal peristalsis along with inadequate relaxation of lower esophageal sphincter . The mainstay of management in achalasia includes pneumatic dilatation, Heller’s myotomy and peroral endoscopic myotomy (POEM). Pneumatic dilatation and Heller’s myotomy have gained maturity over several decades. The current best practice with regard to pneumatic dilatation is graded and on-demand dilatation in appropriately selected cases with type I and II achalasia. Laparoscopic Heller’s myotomy plus partial fundoplication is minimally invasive with reduced postoperative reflux and has virtually replaced open Heller’s myotomy with or without fundoplication. The subtyping of achalasia using high-resolution manometry bears prognostic significance and may help in choosing appropriate therapeutic modality in these patients. Since all the three modalities are effective for type I and II achalasia, the choice among these depends on the availability, expertise, and patient’s preferences. On the other hand, POEM is more effective than pneumatic dilatation and Heller’s myotomy and, therefore, preferred in type III achalasia. Although POEM is effective across the spectrum of esophageal motility disorders, the incidence of gastroesophageal reflux is high and needs to be considered while choosing among various options in these patients. In cases with failed POEM, redo POEM appears to be effective in alleviating symptoms.

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“…In this issue of Gastrointestinal Endoscopy, Urakami et al 9 attempt to address this question by using data analysis to create a predictive scoring model to assign a percentage risk of treatment failure and need for retreatment based on pre-POEM patient characteristics. The authors based this model on a retrospective analysis of 244 patients who underwent POEM between April 2015 and March 2019, and they identified poor responders.…”

mentioning

confidence: 99%

“…Of note, another study by Liu et al 10 has attempted to similarly create a risk-scoring system to predict POEM outcomes. However, unlike the study by Liu et al, 10 which included a number of peri-and postoperative outcomes such as intraoperative injury or the development of postoperative acid reflux, Urakami et al 9 used only preoperative risk factors, which the authors argue increases the clinical utility of this score.…”

mentioning

confidence: 99%