Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia
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Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia. / Verlaan, Tessa; Rohof, Wout O; Bredenoord, Albert J; Eberl, Susanne; Rösch, Thomas; Fockens, Paul.
in: GASTROINTEST ENDOSC, Jahrgang 78, Nr. 1, 01.07.2013, S. 39-44.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia
AU - Verlaan, Tessa
AU - Rohof, Wout O
AU - Bredenoord, Albert J
AU - Eberl, Susanne
AU - Rösch, Thomas
AU - Fockens, Paul
N1 - Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
PY - 2013/7/1
Y1 - 2013/7/1
N2 - BACKGROUND: Pneumatic dilation and laparoscopic Heller myotomy improve parameters of esophageal function such as lower esophageal sphincter (LES) pressure, esophageal emptying, and esophagogastric junction (EGJ) distensibility.OBJECTIVE: To evaluate the effect of peroral endoscopic myotomy (POEM) on esophagogastric function.DESIGN: Prospective trial.SETTING: Endoscopy department at a university hospital.PATIENTS: All consecutive patients aged >17 years with achalasia and an Eckardt score of ≥3.INTERVENTION: Before and 3 months after POEM, 10 consecutive patients underwent esophageal manometry, timed barium esophagograms, and EndoFLIP as well as an EGD.MAIN OUTCOME MEASUREMENTS: Eckardt symptom score, LES resting pressure, centimeters of barium stasis, EGJ distensibility, and reflux esophagitis.RESULTS: Compared with scores before POEM, patient symptom scores were significantly reduced (1, interquartile range [IQR 0-1] vs 8 [IQR 4-8]; P = .005). LES pressure decreased significantly (6.0 mm Hg [IQR 2.6-7.4] vs 19.0 mm Hg [IQR 13.0-28.0]; P = .008). Esophageal emptying increased significantly, and a 5-minute barium column measured 2.3 cm (IQR 0-3.2 cm) versus 10.1 cm (IQR 5.7-10.8 cm; P = .005). EGJ distensibility increased significantly (6.7 mm(2)/mm Hg [IQR 3.8-16.6] vs 1.0 mm(2)/mm Hg [IQR 0.4-2.3]; P = .02) at 50 mL. In 6 of 10 patients, reflux esophagitis was seen. Of these patients, 3 reported reflux symptoms.LIMITATIONS: Small number of patients, short-term follow-up.CONCLUSION: POEM improves esophagogastric function and suggests favorable long-term results based on Eckardt score, esophageal manometry, esophageal emptying, and EGJ distensibility. Long-term follow-up of larger series will determine whether the high rate of reflux esophagitis affects the clinical application of POEM.
AB - BACKGROUND: Pneumatic dilation and laparoscopic Heller myotomy improve parameters of esophageal function such as lower esophageal sphincter (LES) pressure, esophageal emptying, and esophagogastric junction (EGJ) distensibility.OBJECTIVE: To evaluate the effect of peroral endoscopic myotomy (POEM) on esophagogastric function.DESIGN: Prospective trial.SETTING: Endoscopy department at a university hospital.PATIENTS: All consecutive patients aged >17 years with achalasia and an Eckardt score of ≥3.INTERVENTION: Before and 3 months after POEM, 10 consecutive patients underwent esophageal manometry, timed barium esophagograms, and EndoFLIP as well as an EGD.MAIN OUTCOME MEASUREMENTS: Eckardt symptom score, LES resting pressure, centimeters of barium stasis, EGJ distensibility, and reflux esophagitis.RESULTS: Compared with scores before POEM, patient symptom scores were significantly reduced (1, interquartile range [IQR 0-1] vs 8 [IQR 4-8]; P = .005). LES pressure decreased significantly (6.0 mm Hg [IQR 2.6-7.4] vs 19.0 mm Hg [IQR 13.0-28.0]; P = .008). Esophageal emptying increased significantly, and a 5-minute barium column measured 2.3 cm (IQR 0-3.2 cm) versus 10.1 cm (IQR 5.7-10.8 cm; P = .005). EGJ distensibility increased significantly (6.7 mm(2)/mm Hg [IQR 3.8-16.6] vs 1.0 mm(2)/mm Hg [IQR 0.4-2.3]; P = .02) at 50 mL. In 6 of 10 patients, reflux esophagitis was seen. Of these patients, 3 reported reflux symptoms.LIMITATIONS: Small number of patients, short-term follow-up.CONCLUSION: POEM improves esophagogastric function and suggests favorable long-term results based on Eckardt score, esophageal manometry, esophageal emptying, and EGJ distensibility. Long-term follow-up of larger series will determine whether the high rate of reflux esophagitis affects the clinical application of POEM.
KW - Adult
KW - Aged
KW - Esophageal Achalasia
KW - Esophageal Sphincter, Lower
KW - Esophagogastric Junction
KW - Esophagoscopy
KW - Female
KW - Follow-Up Studies
KW - Hospitals, University
KW - Humans
KW - Male
KW - Manometry
KW - Middle Aged
KW - Mouth
KW - Natural Orifice Endoscopic Surgery
KW - Prospective Studies
KW - Recovery of Function
KW - Risk Assessment
KW - Severity of Illness Index
KW - Statistics, Nonparametric
KW - Treatment Outcome
U2 - 10.1016/j.gie.2013.01.006
DO - 10.1016/j.gie.2013.01.006
M3 - SCORING: Journal article
C2 - 23453184
VL - 78
SP - 39
EP - 44
JO - GASTROINTEST ENDOSC
JF - GASTROINTEST ENDOSC
SN - 0016-5107
IS - 1
ER -