Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia

Tessa Verlaan; Wout O Rohof; Albert J Bredenoord; Susanne Eberl; Thomas Rösch; Paul Fockens

doi:10.1016/j.gie.2013.01.006

Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia

Standard

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, Vol. 78, No. 1, 01.07.2013, p. 39-44.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Verlaan, T, Rohof, WO, Bredenoord, AJ, Eberl, S, Rösch, T & Fockens, P 2013, 'Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia', GASTROINTEST ENDOSC, vol. 78, no. 1, pp. 39-44. https://doi.org/10.1016/j.gie.2013.01.006

APA

Verlaan, T., Rohof, W. O., Bredenoord, A. J., Eberl, S., Rösch, T., & Fockens, P. (2013). Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia. GASTROINTEST ENDOSC, 78(1), 39-44. https://doi.org/10.1016/j.gie.2013.01.006

Vancouver

Verlaan T, Rohof WO, Bredenoord AJ, Eberl S, Rösch T, Fockens P. Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia. GASTROINTEST ENDOSC. 2013 Jul 1;78(1):39-44. https://doi.org/10.1016/j.gie.2013.01.006

Bibtex

@article{a1cf7ef2237b4fbe839cd1e2e9af76d9,

title = "Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia",

abstract = "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.",

keywords = "Adult, Aged, Esophageal Achalasia, Esophageal Sphincter, Lower, Esophagogastric Junction, Esophagoscopy, Female, Follow-Up Studies, Hospitals, University, Humans, Male, Manometry, Middle Aged, Mouth, Natural Orifice Endoscopic Surgery, Prospective Studies, Recovery of Function, Risk Assessment, Severity of Illness Index, Statistics, Nonparametric, Treatment Outcome",

author = "Tessa Verlaan and Rohof, {Wout O} and Bredenoord, {Albert J} and Susanne Eberl and Thomas R{\"o}sch and Paul Fockens",

year = "2013",

month = jul,

day = "1",

doi = "10.1016/j.gie.2013.01.006",

language = "English",

volume = "78",

pages = "39--44",

journal = "GASTROINTEST ENDOSC",

issn = "0016-5107",

publisher = "Mosby Inc.",

number = "1",

}

RIS

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

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 -