Thoracic CT after peroral endoscopic myotomy for the treatment of achalasia

Cai, Mingjun; Zhou, Ping‐Hong; Yao, Ling; Zhu, Boqun; Liang, Liang; Li, Quan‐Lin

doi:10.1016/j.gie.2014.05.004

Cited by 60 publications

(36 citation statements)

References 8 publications

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“…Adverse event requiring intervention always has clinical correlate, and we want to stress that the most important parameter in the management of POEM adverse events such as pneumothorax is always the patients' clinical status. We therefore suggest post-POEM CT should be selectively used in symptomatic post-POEM patients [23]. In our study, more than 35 % patients developed gas-related complications and pneumonitis occurred in 75 % patients as judged on CT scan.…”

Section: Discussionmentioning

confidence: 66%

“…Gas-related complications are often of limited clinical significance, and can be resolved with conservative treatments. Because of the rapid diffusion, CO 2 gas instead of room air should be advocated for insufflation to reduce the incidence of gas-related complications [23]. The radiographic and clinical features of pulmonary inflammation on CT scan were more consistent with pneumonitis rather than a frank infection.…”

Section: Discussionmentioning

confidence: 99%

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Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study

Zhou

et al. 2014

Surg Endosc

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106

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study

Zhou

et al. 2014

Surg Endosc

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106

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“…Counting the long-term POEM complication of a reflux structure also as failure, success decreases to 77.5% (62/80). On the other hand, the short-term safety and mid-term safety of the procedure are still high; serious complications that have been described in other papers and also happened at later cases at our institution (mainly pneumothorax and delayed bleeding requiring reintervention/drainage) seem to be low throughout 31 32…”

Section: Discussionmentioning

confidence: 74%

Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years

Werner

Costamagna

Swanström

et al. 2015

Gut

224

166

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“…Intra-procedural bleeding and gas-related events are part of the procedure, occur frequently and are usually inconsequential 26. For the same reason, routine chest computed tomography scan is not justified because of the high rate of minor and clinically irrelevant findings 27. However, caution is advised if tension capno-pericardium develops as cardiac arrest has been reported with this particular gas-related event 28.…”

Section: Discussionmentioning

confidence: 99%

Per-oral endoscopic myotomy for achalasia cardia: outcomes in over 400 consecutive patients

et al. 2017

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Background and study aims Per-oral endoscopic myotomy (POEM) has emerged as an efficacious treatment modality for the management of achalasia cardia (AC) and non-achalasia spastic esophageal motility disorders. Initial results are encouraging. We analyzed the safety and efficacy of POEM in a large cohort of patients with AC. Patients and methods The data from patients who underwent POEM (from January 2013 to June 2016) was prospectively collected and analyzed. Clinical success was defined as Eckardt score ≤ 3 after POEM procedure. Objective parameters including high-resolution manometry (HRM) and timed barium swallow (TBS) were analyzed and compared before and after the procedure. Gastroesophageal reflux was analyzed using 24-hour pH impedance study and esophagogastro-duodenoscopy. Results A total of 408 patients (mean age 40 years, range 4 – 77 years) underwent POEM during the specified period. POEM could be successfully completed in 396 (97 %) patients. Clinical success rates at 1, 2 and 3 years were 94 %, 91 % and 90 %, respectively. Mean Eckardt score was 7.07 ± 1.6 prior to POEM and 1.27 ± 1.06 after POEM (P = 0.001) at 1 year. Significant improvement in esophageal emptying on TBE (> 50 %) was documented in 93.8 % patients who completed 1-year follow up. Pre-procedure and post-procedure mean lower esophageal sphincter pressure was 45 ± 16.5 mmHg and 15.6 ± 6.1 mmHg, respectively (P = 0.001). Technical and clinical success were comparable in naïve vs prior treated cases (97.3 % vs 96.8 %, P = 0.795) (95.7 % vs 92.6 %, P = 0.275). GERD was documented in 28.3 % patients with 24-hour pH-impedance study and erosive esophagitis was seen in 18.5 % of patients who underwent POEM. Conclusions POEM is safe, effective and has a durable response in patients with achalasia cardia. Prior treatment does not influence the outcomes of POEM.

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Thoracic CT after peroral endoscopic myotomy for the treatment of achalasia

Cited by 60 publications

References 8 publications

Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study

Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study

Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years

Per-oral endoscopic myotomy for achalasia cardia: outcomes in over 400 consecutive patients

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