Peroral Endoscopic Myotomy for the Treatment of Achalasia: An International Prospective Multicenter Study

Renteln, Daniel von; Fuchs, Karl–Hermann; Fockens, Paul; Bauerfeind, Peter; Vassiliou, Melina C.; Werner, Yuki B.; Fried, Gerald M.; Breithaupt, Wolfram; Heinrich, Henriette; Bredenoord, Albert J.; Kersten, Jan Felix; Verlaan, Tessa; Trevisonno, Michael; Rösch, Thomas

doi:10.1053/j.gastro.2013.04.057

Cited by 304 publications

(206 citation statements)

References 14 publications

(1 reference statement)

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“…18,19 Recently developed POEM is also effective in lowering LES pressure, but requires longer follow-up and needs to be compared with PD or surgical myotomy. 17,[20][21][22] The most popular protocol of PD is a graded dilatation starting with a 3.0 cm, followed by 3.5 cm and then 4.0 cm balloon, in subsequent sessions balloon. 23 In our institution, a single dilatation with a 3.0 cm balloon is performed as the initial treatment and additional PD is performed according to an "on demand" strategy, based on symptom recurrence during follow-up.…”

Section: Discussionmentioning

confidence: 99%

Association Between Gastroesophageal Reflux Disease After Pneumatic Balloon Dilatation and Clinical Course in Patients With Achalasia

Lee

et al. 2014

J Neurogastroenterol Motil

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Background/AimsThe occurrence of gastroesophageal reflux disease (GERD) is known to be associated with lower post-treatment lower esophageal sphincter pressure in patients with achalasia. This study aimed to elucidate whether GERD after pneumatic balloon dilatation (PD) has a prognostic role and to investigate how the clinical course of GERD is. MethodsA total of 79 consecutive patients who were first diagnosed with primary achalasia and underwent PD as an initial treatment were included in this retrospective study. Single PD was performed using a 3.0 cm balloon. The patients were divided into two groups: 1) who developed GERD after PD (GERD group) and 2) who did not develop GERD after PD (non-GERD group). GERD was defined as pathological acid exposure, reflux esophagitis or typical reflux symptoms. ResultsTwenty one patients (26.6%) developed GERD after PD during follow-up. There were no significant differences between the two groups in demographic or clinical factors including pre-and post-treatment manometric results. All patients in GERD group were well responsive to maintenance proton pump inhibitor therapy including on demand therapy or did not require maintenance. During a median follow-up of 17.8 months (interquartile range, 7.1-42.7 months), achalasia recurred in 15 patients (19.0%). However, the incidence of recurrence did not differ according to the occurrence of GERD after PD. ConclusionsGERD often occurs after even a single PD for achalasia. However, GERD after PD is well responsive to PPI therapy. Our data suggest that GERD after PD during follow-up does not appear to have a prognostic role.

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Section: Discussionmentioning

confidence: 99%

Association Between Gastroesophageal Reflux Disease After Pneumatic Balloon Dilatation and Clinical Course in Patients With Achalasia

Lee

et al. 2014

J Neurogastroenterol Motil

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“…Initially described by Pasricha et al [41], this form of natural orifice transluminal endoscopic surgery (NOTES) has provided adequate symptom relief, shown similar shortterm results, and is less invasive as compared to laparoscopic Heller myotomy [42]. Short-term results have proven that POEM is a safe and effective approach for esophageal achalasia [43][44][45]. The patient is placed in a supine position under general anesthesia [46].…”

Section: Treatmentmentioning

confidence: 99%

Current status of achalasia management: a review on diagnosis and treatment

Tuason

Inoue

2017

J Gastroenterol

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Background Achalasia is a rare esophageal motility disorder that is characterized by loss of peristalsis and failure of relaxation of the lower esophageal sphincter (LES), particularly during swallowing. This review focuses on the diagnosis of esophageal motility disorders as defined by the Chicago Classification ver 3.0, and presents management options with regard to per-oral endoscopic myotomy (POEM) as the treatment of choice. Methods A concise review of literature was performed for articles related to the management of achalasia, and this was contrasted with our institution's current practice. Results Achalasia is still incompletely understood, and management is focused on establishing a proper diagnosis, and relieving the obstructive symptoms. Conclusions Achalasia should be considered when dysphagia is present, and not otherwise caused by an obstruction or inflammation, and when criteria is met as per the Chicago Classification ver 3.0. Lowering LES tone and disruption of LES can be accomplished by various methods, most notably pneumatic balloon dilatation and surgical myotomy. POEM has been gaining momentum as a first line therapy for achalasia symptoms, and can be considered an important tool for motility disorders of the esophagus.

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“…Briefly, it is stated that "For patients with HGD in an endoscopically visible abnormality, endoscopic resection is essential for proper diagnosis and staging. Endoscopic treatment should be preferred over surgical treatment for the management of most patients with BE with HGD and endoscopic treatment of HGD/T1m should only be performed in tertiary referral care centers after proper training of the endoscopists and pathologists involved" (7). The patient's condition is also important when making decisions regarding the preservation of the esophagus and it should be assessed from several areas such as performance status and nutritional state.…”

Section: Endoscopic Submucosal Dissection (Esd)mentioning

confidence: 99%

The impact of flexible endoscopy in esophageal surgery

et al. 2017

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Achalasia and Treatment of esophageal Adenocarcinoma are commonly associated to surgical resection. Newer technologies in interventional endoscopy gave way to a substantial paradigm shift in the management of these conditions. In the case of achalasia, endoscopic myotomy is rapidly displacing Heller's myotomy as the gold standard in many centers. Early stage neoplasia in Barrett's esophagus (BE) comprising high-grade dysplasia (HGD), intramucosal and, in some cases, submucosal carcinoma is now being treated without the need of esophagectomy. This review presents a summary of the most relevant endoscopic techniques for both achalasia and esophageal cancer. Endoscopic advances in diagnostic and therapeutic arenas allow for minimally invasive therapies and organ preservation in most settings of achalasia and early stage neoplasia of the esophagus provided that the clinical setting and physician's expertise are prepared for this approach.

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Peroral Endoscopic Myotomy for the Treatment of Achalasia: An International Prospective Multicenter Study

Cited by 304 publications

References 14 publications

Association Between Gastroesophageal Reflux Disease After Pneumatic Balloon Dilatation and Clinical Course in Patients With Achalasia

Association Between Gastroesophageal Reflux Disease After Pneumatic Balloon Dilatation and Clinical Course in Patients With Achalasia

Current status of achalasia management: a review on diagnosis and treatment

The impact of flexible endoscopy in esophageal surgery

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