Long-term Symptom Control After Laparoscopic Heller Myotomy and Dor Fundoplication for Achalasia

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“…Sanaka et al [29], compared geriatric (> 65 years) vs non-geriatrics (< 65 years) retrospectively, and they found no differences in success at 2 months (94.9 % vs 94.7 %; P = NS), and similar AE (10.1 % vs 3.8 %; P = 0.42), confirming good safety and efficacy. Chen et al [31], in an international multicenter retrospective study, evaluated 76 octogenarian patients and found at mid-term (265 days), a 93.4 % of clinical success, but up to 14.5 % AE, of whom 7.1 % were severe, confirming, that in spite of POEM being safe and effective in younger patients, serious AE could be presented in octogenarian population, being higher in LHM (AE = 3 %-19 %) for these patients [8][9][10]. Low-grade esophagitis was defined as grade A or B according to LA classification system [35] and it was presented in 4.7 % to 11.2 % of our patients during follow-up.…”

“…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…”

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

“…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 . PD has a median perforation rate of 1.9 % 4 8 , and BTI has a temporary effect (mid-term efficacy 22 %–31 %) 11 ; moreover, if a more definite treatment is offered, submucosal fibrosis and mucosal injury rate are increased (4 %–12 %) 2 4 8 .…”

“…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 8 11 ). Fully or partially covered self-expandable metal stents (SEMS) have been used with variable clinical remission rates (88 % to 100 % at early-term and 49 % to 91 % at long-term 12 13 ), but with concerning adverse events (AEs) (thoracic pain 35 % to 44 %, reflux symptoms 28 % to 36 %, migration 8.5 % to 18 %, and bleeding 8 % to 12 % 14 15 16 ).…”

Therapieoptionen von primären Motilitätsstörungen des Ösophagus

“…Dies konnte auf die engmaschigen endoskopischen Verlaufsuntersuchungen zurückgeführt werden. Die Beständigkeit der Ergebnisse im Langzeitverlauf nach LHM + Dor-Semifundoplikatio konnte des Weiteren von Doubova et al verifiziert werden [73]. In dieser Single Center-Analyse hatten die Patienten ebenso eine signifikante Verbesserung der Dysphagie, Odynophagie, Regurgitationen, Refluxbeschwerden sowie der Lebensqualität nach der OP (P < 0,001).…”