Long-term quality of life after peroral endoscopic myotomy remains compromised in patients with achalasia type III

Mondragón, Oscar V. Hernández; Martínez, Marina Alejandra González; Valencia, Juan Manuel Blancas; Reyes, María José; Pineda, Omar; Blanco‐Velasco, Gerardo

doi:10.1055/s-0043-117401

Cited by 26 publications

(56 citation statements)

References 34 publications

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“…52 With regard to POEM treatment, 3 of the 7 studies reported that achalasia type III was associated with failure. [53][54][55] Two Botox studies described that vigorous achalasia was found to be a predictor of good response. 25,56 Other manometric factors.…”

Section: Diagnostic Predictorsmentioning

confidence: 99%

Factors Associated With Achalasia Treatment Outcomes: Systematic Review and Meta-Analysis

Nijhuis

Prins

Mostafavi³

et al. 2020

Clinical Gastroenterology and Hepatology

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This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page page e76. Learning Objective-Upon completion of this activity, successful learners will be able to list the high resolution manometric criteria for diagnosis of achalasia types I, II, and III; list patient risk factors that could influence selection of myotomy procedure in patients with achalasia; recognize relative risks associated with the various treatment options for achalasia; and identify at least one predictive factor of successful outcome of pneumatic dilatation for treatment of achalasia. BACKGROUND & AIMS: Identification of factors associated with achalasia treatment outcome might help physicians select therapies based on patient characteristics. We performed a systematic review and metaanalysis to identify factors associated with treatment response. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library through February 21, 2019, for randomized controlled trials and cohort, case-control, and cross-sectional studies that reported patient-specific outcomes of treatment (botulinum toxin injection, pneumatic dilation, peroral endoscopic myotomy, or laparoscopic Heller myotomy). We assessed the methodologic quality of the included studies using the quality in prognosis studies tool. We planned qualitative and quantitative analyses. RESULTS: We analyzed data from 75 studies (8 randomized controlled trials, 27 prospective cohort studies, and 40 retrospective studies) on a total of 34 different factors associated with outcomes (3 demographic, 17 clinical, and 14 diagnostic factors). Qualitative assessment showed age, manometric subtype, and presence of a sigmoid-shaped esophagus as factors associated with outcomes of treatment for achalasia with a strong level of evidence. The cumulative evidence for the association with chest pain, symptom severity, and lower esophageal sphincter pressure was inconclusive. A meta-analysis confirmed that older age (mean difference, 7.9 y; 95% CI, 1.5-14.3 y) and manometric subtype 3 (odds ratio, 7.1; 95% CI, 4.1-12.4) were associated with clinical response. CONCLUSIONS: In a systematic review and meta-analysis, we found age and manometric subtype to be associated with outcomes of treatment for achalasia. This information should be used to guide treatment decisions.

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Section: Diagnostic Predictorsmentioning

confidence: 99%

Factors Associated With Achalasia Treatment Outcomes: Systematic Review and Meta-Analysis

Nijhuis

Prins

Mostafavi³

et al. 2020

Clinical Gastroenterology and Hepatology

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“…Thin-POEM was effective in the short-term (12 months), confirmed by a decrease in the Eckardt score, IRP, and improved TBE emptying, which is comparable with standard POEM [1,2,5]. Two recurrences were found (both in type III patients), probably related to the different pathophysiology from the other types [13].…”

Section: Discussionmentioning

confidence: 59%

Feasibility of the peroral endoscopic myotomy (POEM) procedure with a new small-caliber endoscope (thin-POEM) in patients with achalasia

et al. 2019

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Background Peroral endoscopic myotomy (POEM) is a recognized technique for patients with achalasia. We aimed to evaluate the feasibility of using a small-caliber endoscope (thin-POEM) to perform POEM in patients with achalasia. Methods Naïve or previously treated patients were included between February 2016 and April 2018. A small-caliber (5.9 mm) nasoendoscope was used, with a modified closure method using cyanoacrylate. Strict follow-up was performed. Results 45 patients were included, aged 45.5 years (interquartile range [IQR] 22 – 69); 53 % (24/45) had type II achalasia. Median total time for thin-POEM was 54 minutes (IQR 37 – 77) and median myotomy length was 13.5 cm (IQR 6 – 20). Results pre-procedure and 3 months post were Eckardt score 10 vs. 1 (P < 0.001), integrated relaxation pressure (IRP) 25.3 vs. 8.5 mmHg (P < 0.001), and timed barium esophagram (TBE) 100 % severely delayed vs. 86 % normal (P < 0.001), respectively. Type III patients had the longest thin-POEM times (median 58 minutes [IQR 52 – 77]). Reflux was confirmed at 3 months clinically in 17 % of patients, endoscopically in 20 %, and on pH monitoring in 53 %. At 6 months and 12 months, 40 % and 33 % of patients remained positive on pH monitoring and were medically managed. Conclusions Thin-POEM seems to be a safe, effective, and efficient procedure for POEM in patients with achalasia, with good short-term follow-up results.

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“…Our dual-POEM success rate is better than one reported by Werner; this suggests that dual-POEM may indeed have the advantage in mitigating the risk of recurrence, avoiding a repeat procedure. As for the patient (type III) who developed recurrence, a different pathophysiology from a different manometric subtype is one of the likely explanations [ 17 ]. However, given our limited number of patients and relatively short follow-up time, further studies with longer follow-up duration are needed to clarify this phenomenon in type III achalasia.…”

Section: Discussionmentioning

confidence: 99%

Per-oral endoscopic dual myotomy for the treatment of achalasia

et al. 2021

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Background Repeat per-oral endoscopic myotomy is occasionally performed for persistent/recurrent symptoms in patients with achalasia, and yields favorable outcomes. We investigated a novel technique, per-oral endoscopic dual myotomy (dual-POEM), where a second myotomy was performed during a single session to augment the efficacy and avoid repeat interventions. The aim of this study was to evaluate its feasibility, safety and efficacy. Methods Consecutive patients diagnosed with achalasia who underwent dual-POEM (1/2018–5/2019) were prospectively collected and retrospectively analyzed. Patients with baseline Eckardt score ≥ 9, ≥ 10 years of symptoms, and/or having prior interventions other than myotomy received dual-POEM. The primary outcome was clinical success (Eckardt score ≤ 3). Secondary outcomes were procedure-related adverse events, change in lower esophageal sphincter (LES) pressure, and reflux complications. Results Seventeen patients received dual-POEM. Procedure-related adverse events were observed in 2 (11.8%) patients (mucosal injury and pneumonitis). Both were minor in severity. During a median follow-up of 33 months (interquartile range, IQR [31,35]; range, 19–36), clinical success was achieved in 16 (94.1%) patients. The median Eckardt score decreased from 9 (IQR [8, 11.5]; range 7–12) to 1 (IQR [1, 2]; range 0–4) (P < 0.001), and LES pressure decreased from 25.8 mmHg (IQR [21.7, 33.5]; range 17.7–46.3) to 7.4 mmHg (IQR [6.3, 10.4]; range 2.2–12.6) (P < 0.001). Seven (41.2%) patients developed postprocedural reflux either by gastroesophageal reflux disease questionnaire or esophagitis endoscopically, all successfully treated with proton pump inhibitors. Conclusion Dual-POEM preliminarily demonstrated high efficacy with a favorable safety profile in patients with achalasia with predictors of treatment failure.

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Long-term quality of life after peroral endoscopic myotomy remains compromised in patients with achalasia type III

Cited by 26 publications

References 34 publications

Factors Associated With Achalasia Treatment Outcomes: Systematic Review and Meta-Analysis

Factors Associated With Achalasia Treatment Outcomes: Systematic Review and Meta-Analysis

Feasibility of the peroral endoscopic myotomy (POEM) procedure with a new small-caliber endoscope (thin-POEM) in patients with achalasia

Per-oral endoscopic dual myotomy for the treatment of achalasia

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