Management of Functional Esophagogastric Junction Outflow Obstruction: A Systematic Review

Garbarino, Stephanie; Isenburg, Megan von; Fisher, Deborah A.; Leiman, David A.

doi:10.14309/00000434-201710001-00395

Cited by 5 publications

(8 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the only systematic review of 8 studies (n = 184 patients) examining medical, endoscopic, and surgical management of EGJOO, no POEM cases were included. Of note, in this study, botulinum toxin injection and expectant management were the two most frequent approaches, with success rates being 58 % and 54 %, respectively [6] There have been a few retrospective studies examining the role of POEM in non-achalasia esophageal motility disorders [7][8][9][10][11][12]. Collectively they have included a total of 3 patients with EGJOO who underwent POEM with promising technical and clinical efficacy; however, these retrospective studies also included other non-achalasia dysmotility disorders in their cohort and are limited by heterogeneous diagnostic and clinical efficacy assessment.…”

Section: Introductionmentioning

confidence: 59%

See 1 more Smart Citation

Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial

et al. 2020

View full text Add to dashboard Cite

Background and study aims Esophagogastric junction outflow obstruction (EGJOO) is a rare esophageal dysmotility disease that is characterized by elevated integrated relaxation pressuse (IRP) with evidence of preserved peristalsis. The role of peroral endoscopic myotomy (POEM) in management of EGJOO is currently unknown. Patients and methods This is a prospective trial conducted in a single US tertiary care center from June 2015 to June 2019. Symptomatic patients, diagnosed with EGJOO on both HRM and endoluminal functional lumen imaging probe (EndoFLIP), who were eligible for POEM were recruited. Primary outcome was clinical success, defined as Eckardt score (ES) ≤ 3, at 6 months post-POEM. Other outcomes included dysphagia score, quality of life as measured by 36-item Short Form health survey scales (SF-36), post-POEM HRM, EndoFLIP, and pH measurements, and adverse events. Results A total of 15 patients (51.8 yr. 9 F) with EGJOO underwent POEM. Pre-POEM mean IRP on HRM and Distensibility index (DI) on EndoFLIP were 24.3 ± 2.2 mmHg and 1.1 ± 0.6 mm2/mmHg, respectively. Clinical success was achieved in 93 % at 6 months post-POEM. There was significant decrease in IRP (-17.6 mmHg) post-POEM. There was significant improvement at 6 months in two of the SF-36 subscales. Ten patients underwent post-POEM pH testing, seven of whom had abnormal DeMeester score. Seven patients underwent EGD evaluation revealing esophagitis in five (2 Los Angeles grade A and 3 grade B). Conclusions POEM offers a high clinical success rate for patients with EGJOO confirmed by impedance planimetry.

show abstract

Section: Introductionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 59%

Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial

et al. 2020

View full text Add to dashboard Cite

show abstract

“…An acknowledgment that Botox is acceptable in high‐risk patients but not a suitable option for other patients was also identified as a valid indicator. The indicator does not address its use prior to more definitive interventions in healthy patients, particularly in equivocal cases such as when achalasia is suspected but manometric findings support EGJOO, 23 or the controversial data demonstrating multiple such injections can attenuate future therapeutic options 24 …”

Section: Discussionmentioning

confidence: 99%

Development of quality indicators for the diagnosis and management of achalasia

Kamal

Kathpalia

Otaki

et al. 2021

Neurogastroenterology Motil

Self Cite

View full text Add to dashboard Cite

Background The management of achalasia has improved due to diagnostic and therapeutic innovations. However, variability in care delivery remains and no established measures defining quality of care for this population exist. We aimed to use formal methodology to establish quality indicators for achalasia patients. Methods Quality indicator concepts were identified from the literature, consensus guidelines and clinical experts. Using RAND/University of California, Los Angeles (UCLA) Appropriateness Method, experts in achalasia independently ranked proposed concepts in a two‐round modified Delphi process based on 1) importance, 2) scientific acceptability, 3) usability, and 4) feasibility. Highly valid measures required strict agreement (≧ 80% of panelists) in the range of 7–9 for across all four categories. Key Results There were 17 experts who rated 26 proposed quality indicator topics. In round one, 2 (8%) quality measures were rated valid. In round two, 19 measures were modified based on panel suggestions, and experts rated 10 (53%) of these measures as valid, resulting in a total of 12 quality indicators. Two measures pertained to patient education and five to diagnosis, including discussing treatment options with risk and benefits and using the most recent version of the Chicago Classification to define achalasia phenotypes, respectively. Other indicators pertained to treatment options, such as the use of botulinum toxin for those not considered surgical candidates and management of reflux following achalasia treatment. Conclusions & Inferences Using a robust methodology, achalasia quality indicators were identified, which can form the basis for establishing quality gaps and generating fully specified quality measures.

show abstract

“…In a study of 16 patients with primary EGJOO treated with pneumatic dilation, Heller myotomy, or Botox injection, only those treated with Heller myotomy responded well [27]. In a systematic review of 8 studies, 82% of patients with primary EGJOO were given botulinum toxin injection or received no intervention (expectant management), with success rates of 58% and 54% respectively, and symptom resolution was similar for all treatment strategies [28 ▪▪ ]. The duration of Botox injection efficacy in patients with EGJOO is not clear, but it has not demonstrated long-lasting effects in patients with achalasia.…”

Section: Management Of Esophagogastric Junction Outflow Obstructionmentioning

confidence: 99%

“…In an older study of 36 patients with elevated IRP (>13 mmHg on HRM), all patients responded to Botox with an average of 12.8 months of symptomatic relief [30]. Botox can also be used as a therapeutic trial to identify patients who might be good candidates for more aggressive interventions like pneumatic dilation, Heller myotomy, and POEM [28 ▪▪ ].…”

Section: Management Of Esophagogastric Junction Outflow Obstructionmentioning

confidence: 99%

Management of the patient with esophagogastric junction outflow obstruction

Shahsavari

Malik

Parkman

2021

Current Opinion in Gastroenterology

View full text Add to dashboard Cite

Purpose of reviewEsophagogastric junction outflow obstruction (EGJOO), defined as elevated integrated residual pressure (IRP) with preservation of esophageal peristalsis, is a common finding on high-resolution esophageal manometry.Recent findingsThe recent Chicago classification version 4.0 proposes changes to the criteria for diagnosing EGJOO, making this diagnosis more restrictive to now include elevated IRP in both supine and upright positions (with preservation of esophageal peristalsis), presence of obstructive symptoms, and confirmatory tests for EGJOO, such as timed barium esophagram with barium tablet or functional lumen imaging probe.SummaryOnce the diagnosis of EGJOO is established, secondary causes need to be ruled out, especially the use of opioid medications. Upper endoscopy is needed for evaluation of EGJOO patients, though cross-sectional imaging is usually not necessary. Many patients improve without intervention; thus, expectant management is recommended for patients with mild or atypical symptoms. There seems to be a limited role for medical treatment. Botox injection into the lower esophageal sphincter is often used to see if the patient improves before committing to more definitive treatments, such as pneumatic dilation, peroral endoscopic myotomy, or Heller myotomy.

show abstract

Management of Functional Esophagogastric Junction Outflow Obstruction: A Systematic Review

Cited by 5 publications

References 0 publications

Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial

Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial

Development of quality indicators for the diagnosis and management of achalasia

Management of the patient with esophagogastric junction outflow obstruction

Contact Info

Product

Resources

About