An international multicenter study evaluating the clinical efficacy and safety of per-oral endoscopic myotomy in octogenarians - 22/03/18

Doi : 10.1016/j.gie.2017.02.007

Yen-I. Chen, MD ¹, Haruhiro Inoue, MD ², Michael Ujiki, MD ³, Peter V. Draganov, MD ⁴, Paul Colavita, MD ⁵, Francois Mion, MD ⁶, John Romanelli, MD ⁷, Philip Chiu, MD ⁸, Valerio Balassone, MD ², Lava Patel, MD ³, Ali Abbas, MD ⁴, Dennis Yang, MD ⁴, Christy Dunst, MD ⁵, Mathieu Pioche, MD ⁶, Sabine Roman, MD ⁶, Jérôme Rivory, MD ⁶, Thierry Ponchon, MD ⁶, David Desilets, MD ⁷, Roberta Maselli, MD ⁹, Manabu Onimaru, MD ², Jun Nakamura, MD ², Yoshitaka Hata, MD ², Gulara Hajiyeva, MD ¹, Amr Ismail, MD ¹, Saowanee Ngamruengphong, MD ¹, Majidah Bukhari, MD ¹, Yamile Haito Chavez, MD ¹, Vivek Kumbhari, MD ¹, Alessandro Repici, MD ⁹, Mouen A. Khashab, MD ^1,^⁎
¹ Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
² Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Koto-Ku, Tokyo, Japan
³ Department of Surgery, Section of Minimally Invasive Surgery, NorthShore University Health System, Evanston, Illinois, USA
⁴ Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
⁵ Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
⁶ Digestive Physiology, Hospices Civils de Lyon and Lyon University, Lyon, France
⁷ Baystate Medical Center, University of Massachusetts School of Medicine, Springfield, Massachusetts, USA
⁸ Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
⁹ Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Milan, Italy

^∗Reprint requests: Mouen A. Khashab, MD, Johns Hopkins Hospital, 1800 Orleans Street, Sheikh Zayed Tower, Baltimore, MD 21287.Johns Hopkins Hospital1800 Orleans StreetSheikh Zayed TowerBaltimoreMD21287

Abstract

Background and Aims

Per-oral endoscopic myotomy (POEM) for achalasia is particularly appealing in the elderly because it is minimally invasive. However, data in patients aged ≥80 years are scarce. The aim of this study was to assess the clinical outcome of POEM in octogenarians.

Methods

This was a multicenter retrospective study at 8 centers. Consecutive octogenarians with achalasia who underwent POEM between 2010 and 2016 were included. Rates of technical success (completion of myotomy), clinical response (Eckardt score ≤3), and adverse events (severity graded as per American Society for Gastrointestinal Endoscopy lexicon) were assessed.

Results

A total of 76 patients (47.4% female, mean age 84 years) underwent POEM for treatment of achalasia: type I, 17.1%; type II, 35.5%; type III, 17.1%; and unspecified, 30.3%. Overall, 41.1% were treatment naïve, whereas others had previous botulinum toxin injection and/or pneumatic dilation. The mean (± standard deviation [SD]) age-adjusted Charlson comorbidity index score was 6.2 ± 2.4, with the majority of patients having American Society of Anesthesiologists Physical Status Classification System (ASA) scores of II/III. Technical success was 93.4%, with a median follow-up of 256 days. Fourteen adverse events occurred in 11 patients (14.5%). There were 3 inadvertent mucosotomies, 6 cases of symptomatic capnoperitoneum and/or capnomediastinum, 2 esophageal leaks, 1 cardiac arrhythmia, and 2 other). The severities of these adverse events were mild (78.6%), moderate (14.3%), and severe (7.1%). Clinical success was achieved in 90.8% of patients, with a mean (± SD) Eckardt score reduction from 7.0 ± 2.3 to 0.8 ± 0.1 (P < .001), a median follow-up of 256 days, and interquartile range of 66 to 547.

Conclusion

Although the rate of technical success may be somewhat lower and the rate of adverse events slightly higher than previously reported, our data suggest that POEM in octogenarians is safe and effective, supporting its role as a primary modality for achalasia in this patient population.

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Abbreviations : ASA, ASGE, BT, POEM

Plan

Methods

Endpoints and definitions

Technical and operative details

DISCLOSURE: M. Khashab is a consultant for Boston Scientific. S. Roman has served as consultant for Medtronic and Sandhill Scientific. All other authors disclosed no financial relationships relevant to this publication.

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Vol 87 - N° 4

P. 956-961 - avril 2018 Retour au numéro

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An international multicenter study evaluating the clinical efficacy and safety of per-oral endoscopic myotomy in octogenarians - 22/03/18

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Background and Aims

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Plan

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