Sa1262 A LARGE SINGLE-CENTER STUDY ON THE CLINICAL OUTCOMES OF PER-ORAL ENDOSCOPIC MYOTOMY FOR SIGMOID TYPE 2 ACHALASIA

Fujiyoshi, Yusuke; Abad, Mary Raina Angeli; Nishikawa, Yohei; Sakaguchi, Takuki; Shimamura, Yuto; Sumi, Kazuya; Kimura, Ryusuke; Izawa, Shinya; Ikeda, Haruo; Onimaru, Manabu; Inoue, Haruhiro

doi:10.1016/j.gie.2020.03.1058

Cited by 3 publications

(7 citation statements)

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“…Table 1 shows the detailed demographic data of the included studies. 3 , 14 - 22 The study that fulfilled the inclusion criteria but was excluded with reason for exclusion is found in ( Supplementary Table ). 16 , 23 Of these 11 studies, 9 were single center retrospective and 1 each was single center prospective and multicenter retrospective.…”

Section: Resultsmentioning

confidence: 99%

“…As advanced achalasia cardia with sigmoid and/or megaesophagus is considered an end stage burnt out disease one would expect the morphological alterations that take place to be permanent and non-modifiable even with treatment. However, POEM has shown promising results even in this parameter with morphological restoration by reducing the diameter of the esophageal body and increas- 15 2020 Nabi et al, 16 2021 Fujiyoshi et al, 19 2020…”

Section: Discussionmentioning

confidence: 99%

“…28, No. 1 January, 2022 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) received, pre-and post-ES, pre-and post-4s-IRP, pre-and post-LESP, duration of follow-up, myotomy length, and definition used for sigmoid esophagus by individual study. For missing data in abstracts, we contacted the authors through electronic mail.…”

Section: Are As Followsmentioning

confidence: 99%

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Role of Peroral Endoscopic Myotomy in Advanced Achalasia Cardia With Sigmoid and/or Megaesophagus: A Systematic Review and Metanalysis

Mandavdhare

Kumar‐M

Shukla

et al. 2022

J Neurogastroenterol Motil

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Background/AimsSigmoid esophagus and/or megaesophagus are considered as an advanced stage in the natural history of achalasia cardia. The role of peroral endoscopic myotomy (POEM) in these subset of patients is emerging. We performed a systematic review and metanalysis to study the efficacy of POEM in advanced achalasia cardia with sigmoid and megaesophagus. MethodsA literature search in PubMed and Embase was done from inception till August 3, 2021 to look for studies reporting exclusively on the role of POEM in advanced achalasia cardia with sigmoid and/or megaesophagus. The random effect method with inverse variance approach was used for the computation of pooled prevalence. For 2 groups' analysis of continuous outcome standardized mean difference was used as the summary measure. ResultsEleven studies with 428 patients were included for analysis. The pooled technical and clinical success was 98.27% (95% CI, 96.19-99.22; I 2 = 0%) and 89.38% (95% CI, 84.49-92.86; I 2 = 26%) and on subgroup analysis into sigmoid and megaesophagus it was (98.06% [95% CI, 95.41-99.19; I 2 = 0%], 98.47% [95% CI, 92.72-99.69; I 2 = 0%] and 87.92% [95% CI, 80.68-92.70; I 2 = 37%], 88.36% [95% CI, 62.62-97.17; I 2 = 77%]) respectively. The clinical success at < 1 year and 1-3 year follow-up was 89.37% (95% CI, 82.82-93.61; I 2 = 0%) and 88.66% (95% CI,; I 2 = 46%) respectively. There was a significant reduction in the post-POEM scores with standardized mean difference for Eckardt score (4.81), for integrated relaxation pressure at 4 seconds (1.93), and for lower esophageal sphincter pressure (2.06). ConclusionsPOEM is an effective modality of treatment even in the subset of patients of advanced achalasia cardia with sigmoid and megaesophagus.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Role of Peroral Endoscopic Myotomy in Advanced Achalasia Cardia With Sigmoid and/or Megaesophagus: A Systematic Review and Metanalysis

Mandavdhare

Kumar‐M

Shukla

et al. 2022

J Neurogastroenterol Motil

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“…However, there was a significant heterogeneity. The sensitivity analysis eliminated the articles of Fujiyoshi et al ( 16 ), and the I 2 decreased from 90 to 69%, MD increased from 5.60 to 5.96 points, p is still <0.00001. The LES pressure was reported in five articles.…”

Section: Resultsmentioning

confidence: 99%

“…However, the dilated, swerved, and rotated tortuous esophageal body may make POEM more technically challenging. Nowadays, some researchers have reported the promising results of POEM in sigmoid-type achalasia (6,(12)(13)(14)(15)(16)(17)(18). Therefore, we conducted this systematic review and meta-analysis aiming to explore the clinical outcome of POEM for sigmoid-type achalasia.…”

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confidence: 99%

Efficacy and Safety of Peroral Endoscopic Myotomy for Sigmoid-Type Achalasia: A Systematic Review and Meta-Analysis

Zhong

Huang³

et al. 2021

Front. Med.

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Background: The efficacy and safety of peroral endoscopic myotomy (POEM) in the treatment of sigmoid-type achalasia is unknown. This meta-analysis aims to explore the clinical outcomes of POEM for sigmoid-type achalasia.Method: We searched all relevant studies published up to September 2020 in PubMed, Embase, and Cochrane library databases. Meta-analyses for clinical success, Eckardt score, angle of esophageal tortuosity, diameter of esophagus, lower esophageal sphincter (LES) pressure, integrated relaxation pressure (IRP), adverse events, and gastroesophageal reflux diseases were performed based on random or fixed-effects models as needed.Results: We found a total of eight studies that provided data on 248 patients. Overall, the pooled clinical success was achieved in 211 sigmoid-type achalasia patients [90.4%; 95% confidence interval (CI), 85.5%−93.8%]. The pre- and post-POEM Eckardt scores, angle of esophageal tortuosity, diameter of esophageal, LES pressure, and IRP were significantly improved (All p < 0.05). The pooled adverse events rate was 13.0% (95% CI, 3.6%−37.4%). The pooled objective confirmation of reflux rate was 41.5% (95% CI, 26.5%−58.3%), and symptomatic reflux rate was 12.5% (95% CI, 8.3%−18.4%).Conclusions: Our current evidence indicated that POEM is an effective and safe therapeutic modality for the treatment of sigmoid-type achalasia.

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Management of End-Stage Achalasia

Juhasz

Arestizábal

Lanzarini

2022

Foregut: The Journal of the American Foregut Society

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Background: End-stage Achalasia correspond to the final stage in the evolution of this disease, characterized by the presence of severe dysphagia and weight loss despite aggressive treatment, associated to massive esophageal dilatation and tortuosity of the esophagus, with loss of its axis and adopting a sigmoid-shape or L-shape distal esophagus. It is also called advanced sigmoid esophagus. The diagnosis is based on radiological evaluations, but different authors use different criteria to define end-stage. This fact makes difficult to compare the results, due to a great heterogeneity of the patients. Methods: Total of 65 reports contently treatment of patients with end stage achalasia were carefully review. Results: Until the year 2000 subtotal esophagectomy with gastric or long-colon interposition was employed as primary treatment or after several medical and endoscopic failed treatments. The mean mortality rate range 3% to 5%, with a high morbidity rate and 10 to 12 days of hospital stay. From 2000 to 2015 Laparoscopic Heller Myotomy (LHM) was employed as the primary treatment, with a mortality rate of 0%, low postoperative morbidity (6%-8%) and 2 days of Hospital stay. The long-term follow up was satisfactory in near 2/3 of the patients with end-stage esophagus. In the last years POEM (Peroral endoscopic Myotomy) has been employed mainly by Asian authors, reporting 0% mortality, high rate of postoperative morbidity (over 20%), a hospital stay of 5 to 7 days and a very short follow up, usually less than 2 years. Although the control of dysphagia is high, the main problem with this technique is the marked increase in pathologic acid reflux to the esophagus, with values near to 50% of the patients. It is not known the late effect 10 to 15 years after this procedure of this severe reflux in an aperistaltic esophagus, with retention of food and acid inside the esophageal lumen. Conclusion: Up to now Laparoscopic Heller Myotomy seems the best option for these patients with severe end-stage esophagus. If there is a failure after this procedure, thoracoscopic esophagectomy would be the best option.

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Sa1262 A LARGE SINGLE-CENTER STUDY ON THE CLINICAL OUTCOMES OF PER-ORAL ENDOSCOPIC MYOTOMY FOR SIGMOID TYPE 2 ACHALASIA

Cited by 3 publications

References 0 publications

Role of Peroral Endoscopic Myotomy in Advanced Achalasia Cardia With Sigmoid and/or Megaesophagus: A Systematic Review and Metanalysis

Role of Peroral Endoscopic Myotomy in Advanced Achalasia Cardia With Sigmoid and/or Megaesophagus: A Systematic Review and Metanalysis

Efficacy and Safety of Peroral Endoscopic Myotomy for Sigmoid-Type Achalasia: A Systematic Review and Meta-Analysis

Management of End-Stage Achalasia

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