Poem Versus Laparoscopic Heller Myotomy in the Treatment of Esophageal Achalasia: A Case-Control Study from Two High Volume Centers Using the Propensity Score

Costantini, Andrea; Familiari, Pietro; Costantini, Mario; Salvador, Renato; Valmasoni, Michele; Capovilla, Giovanni; Landi, Rosario; Mangiola, Francesca; Provenzano, Luca; Briscolini, Dario; Merigliano, Stefano; Costamagna, Guido

doi:10.1007/s11605-019-04465-w

Cited by 47 publications

(44 citation statements)

References 47 publications

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“…The therapy consists of dissection of the circular muscle bundle through a previously created submucosal tunnel at the gastroesophageal junction; after completion, the mucosal entry is closed with hemostatic clips. Symptom control after POEM is comparable to that seen with laparoscopic Heller myotomy (LHM) [54][55][56] . If achalasia presents in post-bariatric patients, the management remains the same as with a normal anatomy patient.…”

Section: Achalasia In Bariatricsmentioning

confidence: 77%

Bariatric endoscopy: current primary therapies and endoscopic management of complications and other related conditions

Castro¹,

Guerron²

2020

Mini-invasive Surg

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The steady increase in bariatric surgery has led to room for innovation. Endoscopy has become an important tool for evaluation, diagnosis, management of complications, and even for primary bariatric interventions. Leaks are the most feared complication and new endoscopic therapies have been developed such as septotomy, doublepigtail stents, and endoscopic vacuum therapy. Additionally, primary bariatric endoscopic procedures are gaining popularity and the new procedures include intragastric balloons, stoma reduction, aspiration therapy, among others. The altered anatomy and reoperation increase the risk of complications after bariatric surgery, especially when managing conditions like achalasia, gastroparesis, and cholelithiasis. Per-oral endoscopic myotomy, per-oral pyloromyotomy, and endoscopic ultrasound-guided transgastric endoscopic retrograde cholangiopancreatography provide a less invasive approach to address these conditions. This narrative review article intends to expose current endoscopic therapies for the management of primary bariatric procedures, complications and related conditions.

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Section: Achalasia In Bariatricsmentioning

confidence: 77%

Bariatric endoscopy: current primary therapies and endoscopic management of complications and other related conditions

Castro¹,

Guerron²

2020

Mini-invasive Surg

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“…We have been using the Dor fundoplication. Post-LHD reflux esophagitis occurrence rates vary between 6-35% [18,[23][24][25]. This wide range of recurrence rates may be due to the different times elapsed until post-operative endoscopy and follow-up durations.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of laparoscopic Heller myotomy with Dor-fundoplication in surgical treatment of achalasia: A single-center experience

Sürmelioğlu¹,

Akkuş²

2021

Journal of Surgery and Medicine

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Background/Aim: Laparoscopic Heller myotomy with Dor fundoplication (LHD) is a widely used surgical method in achalasia treatment. However, it has not been well studied in terms of symptomatic relief effect and anti-reflux success in the long term. This study aimed to investigate the long-term success of LHD on symptom relief and acid reflux control. Methods: Patients who underwent LHD between February 2011 and June 2020 were included in this retrospective cohort study. Patients' demographics, post-operative follow-up outcomes and esophagitis signs on endoscopy were retrieved from the institutional database. Eckardt scores of all study patients were calculated. Those with insufficient follow-up data were excluded. Disease free rates were calculated using the Kaplan-Meier analysis. Results: A total of 24 patients, 11 males and 13 females, were included. The mean age of all patients was 47.9 (11.3) years. The median follow-up time was 71.0 (12.0-117.0) months. Cumulative symptomatic relief (Eckardt ≤3) rate of LHD was 87.5% (21/24). Kaplan-Meier analysis showed that the timedependent probability of Eckardt score being ≤3 at 3 and 5 years after the surgery were 100% and 94.7%, respectively. The mean expected survival time with Eckardt score ≤3 was 102.5 (95% CI: 87.6-117.3) months. The post-LHD esophagitis rate was 20.8% (5/24). The probability of no reflux esophagitis at 3 and 5 years after the surgery were 95.0% and 89.4%, respectively. The mean expected esophagitis-free survival was 94.2 (95% CI: 80.6-107.7) months. Conclusion: LHD seems successful and safe in terms of long-term symptomatic relief and acid reflux control in the surgical treatment of achalasia.

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“…Treatment failure was defined as the persistence or reoccurrence of an Eckardt score > 3 or the need for retreatment. 9 , 10 …”

Section: Methodsmentioning

confidence: 99%

“…Treatment failure was defined as the persistence or reoccurrence of an Eckardt score > 3 or the need for retreatment. 9,10 The study was approved by the institutional review board at Padova General Hospital and by the Research Committee of the Department of Surgical, Oncological, and Gastroenterological Sciences at Padova University. Research is being reported in line with the STROCCS criteria.…”

Section: Egjoo Padova Protocolmentioning

confidence: 99%

Laparoscopic Heller-Dor Is an Effective Treatment for Esophageal-Gastric Junction Outflow Obstruction

Salvador

Provenzano

Nezi

et al. 2021

Journal of Gastrointestinal Surgery

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Background The treatment of esophagogastric junction outflow obstruction (EGJOO) currently mirrors that of achalasia, but this is based on only a few studies on small case series. The aim of this prospective, controlled study was to assess the outcome of laparoscopic Heller-Dor (LHD) in patients with EGJOO, as compared with patients with esophageal achalasia. Materials and Methods Between 2016 and 2019, patients with manometric diagnosis of idiopathic EGJOO and patients with radiological stage I achalasia, both treated with LHD, were compared. The achalasia group was further analyzed by subgrouping the patients based on the manometric pattern. Treatment failure was defined as the persistence or reoccurrence of an Eckardt score > 3 or the need for retreatment. Results During the study period, 150 patients were enrolled: 25 patients had EGJOO and 125 had radiological stage I achalasia (25 pattern I, 74 pattern II, and 26 pattern III). The median follow-up was 24 months (IQR: 34–16). Treatment was successful in 96% of patients in the EGJOO group and in 96% of achalasia patients with pattern I, 98.7% in those with pattern II, and 96.2% of those with pattern III (p=0.50). High-resolution manometry showed a reduction in the LES resting pressure and integrated relaxation pressure for all patients in all 4 groups (p<0.001). Conclusion This is the first comparative study based on prospective data collection to assess the outcome of LHD in patients with EGJOO. LHD emerged as an effective treatment for EGJOO, with an excellent success rate, comparable with the procedure’s efficacy in treating early-stage achalasia.

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Poem Versus Laparoscopic Heller Myotomy in the Treatment of Esophageal Achalasia: A Case-Control Study from Two High Volume Centers Using the Propensity Score

Cited by 47 publications

References 47 publications

Bariatric endoscopy: current primary therapies and endoscopic management of complications and other related conditions

Bariatric endoscopy: current primary therapies and endoscopic management of complications and other related conditions

Long-term results of laparoscopic Heller myotomy with Dor-fundoplication in surgical treatment of achalasia: A single-center experience

Laparoscopic Heller-Dor Is an Effective Treatment for Esophageal-Gastric Junction Outflow Obstruction

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