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Gastrointestinal Endoscopy

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International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video) - 01/06/16

Doi : 10.1016/j.gie.2014.10.011 
Mouen A. Khashab, MD 1, ⁎, Ahmed A. Messallam, MD 1, Manabu Onimaru, MD, PhD 2, Ezra N. Teitelbaum, MD 3, Michael B. Ujiki, MD 4, Matthew E. Gitelis, BS 4, Rani J. Modayil, MD 5, Eric S. Hungness, MD 3, Stavros N. Stavropoulos, MD 5, Mohamad H. El Zein, MD 1, Hironari Shiwaku, MD 6, Rastislav Kunda, MD 7, Alessandro Repici, MD 8, Hitomi Minami, MD, PhD 9, Philip W. Chiu, MD 10, Jeffrey Ponsky, MD 11, Vivek Kumbhari, MD 1, Payal Saxena, MD 1, Amit P. Maydeo, MD 12, Haruhiro Inoue, MD, PhD 2
1 Johns Hopkins Medical Institute, Baltimore, Maryland, USA 
2 Showa University Northern Yokohama Hospital, Yokohama, Japan 
3 Northwestern University, Chicago, Illinois, USA 
4 North Shore University Health System, Evanston, Illinois, USA 
5 Winthrop University Hospital, Mineola, New York, USA 
6 Fukuoka University Faculty of Medicine, Fukuoka, Japan 
7 Aarhus University Hospital, Aarhus, Denmark 
8 Humanitas Research Hospital, Milano, Italy 
9 Nagasaki University Hospital, Nagasaki, Japan 
10 Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong, China 
11 University Hospitals Case Medical Center, Cleveland, Ohio, USA 
12 Baladota Institute of Digestive Sciences, Mumbai, India 

∗Reprint requests: Mouen A. Khashab, MD, Assistant Professor of Medicine, Director of Therapeutic Endoscopy, Johns Hopkins Hospital, 1800 Orleans St, Suite 7125 B, Baltimore, MD 21205.

Abstract

Background

Limited data exist on the use of peroral endoscopic myotomy (POEM) for therapy of spastic esophageal disorders (SEDs).

Objective

To study the efficacy and safety of POEM for the treatment of patients with diffuse esophageal spasm, jackhammer esophagus, or type III (spastic) achalasia.

Design

Retrospective study.

Setting

International, multicenter, academic institutions.

Patients

All patients who underwent POEM for treatment of SEDs refractory to medical therapy at 11 centers were included.

Interventions

POEM.

Main Outcome Measurements

Eckardt score and adverse events.

Results

A total of 73 patients underwent POEM for treatment of SEDs (diffuse esophageal spasm 9, jackhammer esophagus 10, spastic achalasia 54). POEM was successfully completed in all patients, with a mean procedural time of 118 minutes. The mean length of the submucosal tunnel was 19 cm, and the mean myotomy length was 16 cm. A total of 8 adverse events (11%) occurred, with 5 rated as mild, 3 moderate, and 0 severe. The mean length of hospital stay was 3.4 days. There was a significant decrease in Eckardt scores after POEM (6.71 vs 1.13; P = .0001). Overall, clinical response was observed in 93% of patients during a mean follow-up of 234 days. Chest pain significantly improved in 87% of patients who reported chest pain before POEM. Repeat manometry after POEM was available in 44 patients and showed resolution of initial manometric abnormalities in all cases.

Limitations

Retrospective design and selection bias.

Conclusion

POEM offers a logical therapeutic modality for patients with SEDs refractory to medical therapy. Results from this international study suggest POEM as an effective and safe platform for these patients.

Il testo completo di questo articolo è disponibile in PDF.

Abbreviations : DCI, DES, HRM, IRP, LES, POEM, SED


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 DISCLOSURE: M. Khashab is a consultant for Boston Scientific and Olympus America and has received research support from Cook Medical. H. Inoue is a founding member, equity holder, and consultant for Apollo Endosurgery. No other financial relationships relevant to this article were disclosed.
 See CME section; p. 1237.
 If you would like to chat with an author of this article, you may contact Dr Khashab at mkhasha1@jhmi.edu.


© 2015  American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 81 - N° 5

P. 1170-1177 - maggio 2015 Ritorno al numero
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