Clinical and financial outcomes of per-oral endoscopic myotomy compared to laparoscopic heller myotomy for treatment of achalasia

Shally, Lena; Saeed, Kashif; Berglund, Derek D.; Dudash, Mark; Frank, Katie; Obradovic, Vladan N.; Petrick, Anthony T.; Diehl, David L.; Gabrielsen, Jon; Parker, David M.

doi:10.1007/s00464-022-09652-6

Cited by 5 publications

(2 citation statements)

References 38 publications

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“…These studies include a total of 5139 participants, of which 1394 underwent POEM and 3745 underwent LHM. All studies were retrospective observational studies [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. Detailed information on study characteristics and details of the patients was presented in Table 1.…”

Section: Search Results and Characteristics Of The Included Studiesmentioning

confidence: 99%

Achalasia: laparoscopic Heller myotomy with fundoplication versus peroral endoscopic myotomy—a systematic review and meta-analysis

Sobral,

Machado,

Barbosa

et al. 2024

Esophagus

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There are various therapeutic options for achalasia. Nevertheless, peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy with fundoplication (LHM) are distinguished by their efficacy and low incidence of complications. Compare POEM and LHM regarding several outcomes in patients with achalasia. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An exhaustive literature search was performed using PubMed, Web of Science, and Cochrane Library databases. Studies comparing several outcomes between POEM and LHM in patients with achalasia were included. Data on clinical success, operative time, intraoperative complications, length of stay, reintervention rates, postoperative pain, overall complications, occurrence of GERD symptoms, use of proton bomb inhibitors and esophagitis were extracted. Quality assessment of the included studies was performed using the MINORS scale. We included 20 retrospective observational studies with a combined total of 5139 participants. The results demonstrated that there was no statistically significant difference in terms of intraoperative complications, postoperative complications, reintervention rate, occurrence of GERD symptoms, GERD HRQL, use of proton pump inhibitors, and esophagitis between POEM and LHM groups. Conversely, POEM was associated with higher clinical success and shorter operative time, length of stay, and postoperative pain. This meta-analysis concludes that both POEM and LHM, are effective and safe treatments for achalasia. However, POEM demonstrates better results regarding clinical success, operative time, length of stay, postoperative pain, and a tendency towards lower recurrence.

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Section: Search Results and Characteristics Of The Included Studiesmentioning

confidence: 99%

Achalasia: laparoscopic Heller myotomy with fundoplication versus peroral endoscopic myotomy—a systematic review and meta-analysis

Sobral,

Machado,

Barbosa

et al. 2024

Esophagus

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“…Тактика лікування АС зараз широко обговорюється, оскільки навіть оперативне лікування не завжди дає обнадійливі результати [14]. На початкових стадіях розвитку цієї патології досить ефективним є застосування консервативних методів, доповнених балонною пневмокардіодилатацією.…”

Section: вступunclassified

Endoscopic ultrasonography in the assessment of physiological cardia in esophageal achalasia

Babii,

Prolom,

Shevchenko

et al. 2024

GASTRO

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Background. Recently, to assess the physiological cardia in esophageal achalasia (EA), the method of endoscopic ultrasonography (EUS) has been used, which combines the capabilities of two studies, endoscopic and ultrasound, in addition to traditional diagnostic methods, radiography and endoscopy, and allows detecting structural changes in the esophageal wall and lower esophageal sphincter (LES). Objective: to determine the role of endoscopic ultrasonography in assessing the state of physiological cardia in esophageal achalasia. Materials and methods. In the Department of Digestive Surgery of the SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” in 2023–2024, according to the objectives of the study, 15 patients with EA and 20 practically healthy individuals (control group) were examined. All patients underwent X-ray and endoscopic examination of the oesophagus, stomach, duodenum, and EUS. Results. Videoesophagogastroduodenoscopy revealed changes characteristic of EA: dilation of the esophageal diameter (100.0 %), stagnant contents in the esophageal lumen (66.7 %), resistance to the passage of an endoscope through LES (86.7 %). X-ray revealed EA stage I in 13.3 % of cases by peristalsis and esophageal diameter, stage II — in 33.3 %, stage III — in 46.7 %, and stage IV — in 6.7 % of cases. When performing EUS, the esophageal hiatus was 19.29 mm (normal 23–36 mm); the esophageal wall thickness in the middle third was 6.76 mm (normal < 3 mm); the LES wall thickness was 6.02 mm (normal < 5 mm). To detect fibrotic changes in the esophageal and the LES wall, compression elastography was used. This method helped reveal a significant thickening of the internal circular muscle of the LES from 2.5 to 4.5 mm in 46.6 % of cases, and in 26.6 %, with EA stage III and IV, fibrotic changes were detected in the lower third of the esophageal wall. Conclusions. It has been found that EUS in EA answers questions that are not answered by traditional research methods, namely, it makes it possible to assess a number of parameters (thickness of the walls of the LES and the lower third of the esophagus, diameter of the esophageal hiatus) and identify structural changes (the presence of fibrosis), which significantly affects the choice of a method for a surgical correction of physiological cardia in EA.

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Endoscopic treatment of achalasia: Dim past, brighter future?

Estevinho

Freitas

Pinho

2023

Gastrointestinal Endoscopy

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Clinical and financial outcomes of per-oral endoscopic myotomy compared to laparoscopic heller myotomy for treatment of achalasia

Cited by 5 publications

References 38 publications

Achalasia: laparoscopic Heller myotomy with fundoplication versus peroral endoscopic myotomy—a systematic review and meta-analysis

Achalasia: laparoscopic Heller myotomy with fundoplication versus peroral endoscopic myotomy—a systematic review and meta-analysis

Endoscopic ultrasonography in the assessment of physiological cardia in esophageal achalasia

Endoscopic treatment of achalasia: Dim past, brighter future?

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