Changes in pressure waves after endoscopic intervention in patients with achalasia: A focus on peristaltic recovery of the esophageal body

Park, Se Kyung; Hong, Su Jin; Han, Jae Pil; Goong, Hyeon Jeong; Kim, Hyun Soo; Myung, Yu Sik; Kim, Shin Hee; Jung, Hyun-Joo; Lee, Tae Hee; Lee, Joon Seong; Lee, Moon Sung

doi:10.5152/tjg.2015.150271

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…Furthermore, normalization of the nadir relaxation pressure of the LES is found to be a predictive factor for the recovery of esophageal peristalsis and therefore for the success of treatment [10].…”

Section: Discussionmentioning

confidence: 93%

“…The first-line treatment is still debated in the medical community: some authors prefer pneumatic endoscopic dilatation, others the endoscopic injection of botulinum toxin, and yet others surgery [1,2,[9][10][11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

“…In the medical literature the debate remains open about predictors of the outcome of surgical treatment, among which are the resting pressure of the LES (PRPLES), the severity of preoperative symptoms, the preoperative duration of symptoms, a sigmoid esophagus, previous endoscopic treatments, the diameter of the esophagus, amotility of the esophagus, and the nadir relaxation pressure of the LES [10,[26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

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Esophageal Achalasia: Predictive Value of Preoperative Resting Pressure of LES Correlated with Type of Fundoplication

et al. 2017

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Objective: The aim of the present study is to show the predictive value of the preoperative resting pressure of the lower esophageal sphincter (LES) correlated with the type of fundoplication (Nissen or Dor) after Heller myotomy in our series. Materials and Methods:From January 1998 to June 2010, 88 patients affected by esophageal achalasia underwent surgery at our unit. However, our study focused on a sample of 36 patients, because many data were lost or was never recorded. Among these, 14 patients underwent laparoscopic Heller myotomy plus Nissen fundoplication (group N), whereas 22 patients underwent laparoscopic Heller myotomy plus Dor fundoplication (group D). Clinical evaluation was performed using a modified DeMeester symptom scoring system consisting of the assessment of three symptoms: dysphagia, regurgitation, and heartburn. To each symptom was assigned a score from 0 to 3, depending on its severity, and the reduction in the severity of each symptom after surgery was assessed.Results: The surgical treatment is considered to be effective (p<0.0001). The preoperative resting pressures of LES were compared by Student's t-test, and it was found that patients who reported a greater improvement in the dysphagia symptom had a preoperative average pressure of LES that was significantly higher than that in other patients in both group N (p=0.03) and group D (p=0.01; p=0.003; p=0.001). The Dor treatment was shown to be more effective than the Nissen treatment (p<0.0001). Conclusion:The preoperative resting pressure of LES is a predictive factor of surgical success both before Dor fundoplication and before Nissen fundoplication, but its predictive power is influenced by the chosen type of fundoplication.Keywords: Achalasia, dysphagia, preoperative resting pressure of LES, predictive factors, fundoplication ÖZ Amaç: Bu çalışmanın amacı, serimizdeki Heller miyotomi sonrasında, funduplikasyon türü (Nissen veya Dor) ile ilişkili olarak alt özofageal sfinkterin (AÖS) preoperatif istirahat basıncının prediktif değerini göstermektir.Gereç ve Yöntem: Ocak 1998 ile Haziran 2010 arasında, özofageal akalazyadan etkilenen 88 hasta birimimizde ameliyat oldular. Ancak çalışmamızda, birçok verinin kaybolmasından veya hiç kaydedilmemiş olmasından dolayı, 36 hastaneden oluşan bir örnekleme odaklanıldı. Bu hastalardan 14'üne laparoskopik Heller miyotomi+Nissen fundoplikasyon (N grubu) uygulanırken, 22'sine laparoskopik Heller miyotomi+Dor fundoplikasyon (D grubu) uygulandı. Klinik değerlendirme, disfaji, regürjitasyon ve mide yanması olan üç semptomun değerlendirilmesini içeren modifiye DeMeester semptom skorlama sistemi kullanılarak yapıldı. Her bir semptoma 0 ile 3 arası bir puan verildi ve ameliyat sonrası her semptomun şiddetindeki azalma değerlendirildi.Bulgular: Cerrahi tedavinin etkili olduğu düşünülmektedir (p<0,0001). Ameliyat öncesi AÖS istirahat basınçları Student's t-test ile karşılaştırıldı. Disfaji semptomunda gelişme görülen hastalarda ameliyat öncesi ortalama AÖS basıncı, N grubu (p=0,03) ve D grubundaki (p...

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Esophageal Achalasia: Predictive Value of Preoperative Resting Pressure of LES Correlated with Type of Fundoplication

et al. 2017

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“…Esophageal motility disorders are gradually being recognized. Current therapy directly targets obstructions in the esophagus [10,11]; however, using these methods does not fully alleviate esophageal peristaltic function [12,13]. In order to restore normal physiological function of the esophagus, it is essential to develop treatment strategies to regain proper peristalsis of the esophagus.…”

Section: Discussionmentioning

confidence: 99%

An Animal Study of Implantation of an Esophageal Pacemaker Based on Per-Oral Endoscopic Myotomy Approach for Alleviation of Esophageal Peristalsis Disorders

Chen

Zhang

et al. 2020

Med Sci Monit

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Departmental sources Background:To restore esophageal peristalsis of achalasia patients by sequenced electric stimulation, an appropriate method must be established to implant the electrodes and pacemaker safely and effectively. We combined POEM (per-oral endoscopic myotomy) and abdominal wall puncture in pigs in order to explore a feasible procedure for the implantation. Material/Methods:Five healthy male pigs were used in the present study with the permission of the Ethics Committee of Tianjin Medical University General Hospital. The electrodes were implanted in esophageal submucosal tunnel by POEM with the end of the electrode deposited in the abdominal cavity using NOTES technique. A pacemaker was then positioned under the skin of the abdomen. Finally, the electrodes were connected with the pacemaker with the help of endoscopy in the abdominal cavity. Esophageal peristalsis of these pigs after implantation was monitored for esophageal intraluminal pressure changes using electronic gastroscopy and a high-resolution manometry (HRM). The observation lasted for 6 h. Results:The procedure was effective to implant the electrode and the pacemaker using POEM and NOTES techniques.The connection of the 2 devices was also successful. Esophageal intraluminal pressure changes after electrical stimulation were recorded using HRM. Vital signs of the pigs were stable during the 6-h follow-up. Conclusions:From this small-sample, short follow-up animal study, it was found that the implantation of esophageal electrodes and pacemaker based on POEM and NOTES is feasible, safe, and effective. Nevertheless, there is urgent need for long-term follow-up to confirm or disprove the safety of the procedure.

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“…Achalasia is a motility disorder characterized by impaired low-er esophageal sphincter loosening and abnormal esophageal peristalsis. It is caused by the loss of ganglion cells in the esophageal myenteric plexus that regulate loosening of the lower esophageal sphincter and esophageal peristalsis [4]. Endoscopic balloon dilatation is an effective treatment for achalasia [5,6].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of endoscopic balloon dilatation of esophageal strictures without fluoroscopy: a pilot study

Dincer¹,

Akıncı²

2018

Arch Med Sci Civil Dis

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I n t r o d u c t i o n Introduction: Esophageal strictures can be caused by malignancy, congenital stenosis, motility disorders or benign strictures. Endoscopic balloon dilatation is a simple procedure with low complication rates to treat gastrointestinal strictures. This study aims to analyze indications and results of balloon dilatation without fluoroscopy. Material and methods: The patients who underwent pneumatic balloon dilatation (PBD) for esophageal stricture were included in the study. The demographic characteristics of the patients, indications for PBD, number of operations and complications were recorded. Results: Twelve patients were included in this pilot study. The most common cause of esophageal strictures was malignancy. In this group, PBD was performed before stenting in the patients who were planned to receive neoadjuvant therapy, had locally advanced esophageal cancer or inoperable esophageal cancer, and complained of difficulty swallowing. Three patients underwent PBD due to achalasia. One of these patients underwent PBD 3 times due to recurrence of symptoms during the follow-up period. The success rate of PBD in this study was 91.6%. The success rate for the patients who underwent PBD for the first time was 83.3%. None of the patients who underwent endoscopic balloon dilatation had major complications (such as massive bleeding and perforation) or procedural mortality. Conclusions: Endoscopic balloon dilatation without fluoroscopy performed by experienced endoscopists is an effective and safe method for the treatment of esophageal strictures. Successful results are obtained with low complication rates in experienced centers.

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Changes in pressure waves after endoscopic intervention in patients with achalasia: A focus on peristaltic recovery of the esophageal body

Cited by 4 publications

References 14 publications

Esophageal Achalasia: Predictive Value of Preoperative Resting Pressure of LES Correlated with Type of Fundoplication

Esophageal Achalasia: Predictive Value of Preoperative Resting Pressure of LES Correlated with Type of Fundoplication

An Animal Study of Implantation of an Esophageal Pacemaker Based on Per-Oral Endoscopic Myotomy Approach for Alleviation of Esophageal Peristalsis Disorders

Efficacy and safety of endoscopic balloon dilatation of esophageal strictures without fluoroscopy: a pilot study

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