Clinical outcomes and safety of high-resolution manometry guided superficial partial circular muscle myotomy in per-oral endoscopic myotomy for Jackhammer esophagus: Two cases report

Choi, Youn I; Kim, Kyoung Oh; Park, Dong Kyun; Chung, Jun‐Won; Kim, Yoon Jae; Kwon, Kwang An

doi:10.12998/wjcc.v7.i16.2322

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…This refined technique involves determining the level of esophageal hypertension via HREM, conserving the lower esophageal sphincter, and only partially removing the outer layer of the ringed muscle, rather than a full removal. Postoperatively, all symptoms were resolved within a year without complications [18]. Although POEM remains the primary endoscopic treatment for this ailment, other strategies, such as endoscopic carnitine injection and balloon dilation, have been considered [19,20].…”

Section: Discussionmentioning

confidence: 99%

A rare case of Jackhammer esophagus presenting with reflux-like symptoms in Guizhou, China

Yang,

Huang,

Chen

et al. 2023

Open J Clin Med Case Rep

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Jackhammer Esophagus (JE) is a rare esophageal motility disorder characterized by hyperdynamic contraction of the distal esophagus. High-Resolution Esophageal Manometry (HREM) remains the diagnostic benchmark. Clinically, JE manifests as dysphagia, chest pain, and symptoms suggestive of gastroesophageal reflux [1] often leading to misdiagnosis as Gastroesophageal Reflux Disease (GERD). Treatment approaches lack unified guidelines, with notable variability in outcomes. Initial management typically favors medical interventions [2]. This article examines the diagnostic and therapeutic journey of a JE case and provides insights into recent advancements in its diagnosis and management.

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Section: Discussionmentioning

confidence: 99%

A rare case of Jackhammer esophagus presenting with reflux-like symptoms in Guizhou, China

Yang,

Huang,

Chen

et al. 2023

Open J Clin Med Case Rep

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“…Partial circular muscle myotomy is a technique that involves cutting only the superficial layer of the esophageal circular muscle and preserving the circular and longitudinal muscle layers. A recent report from South Korea described 2 patients with JE who were successfully treated with HREM-guided superficial partial circular muscle myotomy during POEM 100. More experience is required with this novel technique before it can be implemented routinely.…”

Section: Medical Therapymentioning

confidence: 99%

“…A recent report from South Korea described 2 patients with JE who were successfully treated with HREMguided superficial partial circular muscle myotomy during POEM. 100 More experience is required with this novel technique before it can be implemented routinely.…”

Section: Poemmentioning

confidence: 99%

Jackhammer Esophagus

Achem

Vázquez-Elizondo²,

Fass

2020

Journal of Clinical Gastroenterology

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Jackhammer esophagus (JE) is a recently recognized esophageal motility disorder that is characterized by hypercontractile peristalsis. More than 500 cases have been reported in the literature. Among patients referred for esophageal motility disorders, the prevalence of JE ranges from 0.42% to 9%, with most series describing a prevalence of 2% to 4%. Most cases are women (60.5%). The mean reported age of patients with JE is 65.2 years, and patients commonly have dysphagia (62.8%). Reflux symptoms occur in ∼40% of patients, and chest pain affects more than one-third of patients (36.4%). JE is a heterogenous disorder that is associated with several conditions, including obesity, opioid use, lung transplantation, eosinophilic infiltration of the esophagus, neoplasia, and systemic diseases. The cause and pathogenesis remain unknown, but several observations suggest that it is the result of multiple conditions that likely precipitate increased excitation and abnormal inhibition of neuromuscular function. The natural course of JE also is unknown, but progression to achalasia has been observed in a few patients. Treatment is challenging, in part because of the insufficient understanding of the disorder's underlying mechanisms. Various therapeutic modalities have been used, ranging from observation only to pharmacologic and endoscopic interventions (eg, botulinum toxin injection) to peroral endoscopic myotomy. Treatment efficacy remains largely anecdotal and insufficiently studied.

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Peroral endoscopic myotomy for hypercontractile (Jackhammer) esophagus: A retrospective multicenter series with long‐term follow‐up

Albers,

Witt,

Pandolfino

et al. 2024

UEG Journal

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IntroductionLong‐term outcome data are limited for non‐achalasia esophageal motility disorders treated by peroral endoscopy myotomy (POEM) as a separate group. We investigated a subset of symptomatic patients with hypercontractile esophagus (Jackhammer esophagus).MethodsForty two patients (mean age 60.9 years; 57% female, mean Eckardt score 6.2 ± 2.1) treated by primary peroral myotomy for symptomatic Jackhammer esophagus 2012–2018 in seven European centers were retrospectively analyzed; myotomy included the lower esophageal sphincter but did not extend more than 1 cm into the cardia in contrast to POEM for achalasia. Manometry data were re‐reviewed by an independent expert. The main outcome was the failure rate defined by retreatment or an Eckardt score >3 after at least two years following POEM.ResultsDespite 100% technical success (mean intervention time 107 ± 48.9 min, mean myotomy length 16.2 ± 3.7 cm), the 2‐year success rate was 64.3% in the entire group. In a subgroup analysis, POEM failure rates were significantly different between Jackhammer‐patients without (n = 22), and with esophagogastric junction outflow obstruction (EGJOO, n = 20) (13.6% % vs. 60%, p = 0.003) at a follow‐up of 46.5 ± 19.0 months. Adverse events occurred in nine cases (21.4%). 14 (33.3%) patients were retreated, two with surgical fundoplication due to reflux. Including retreatments, an improvement in symptom severity was found in 33 (78.6%) at the end of follow‐up (Eckardt score ≤3, mean Eckardt change 4.34, p < 0.001). EGJOO (p = 0.01) and frequency of hypercontractile swallows (p = 0.02) were predictors of POEM failure. The development of a pseudodiverticulum was observed in four cases within the subgroup of EGJOO.ConclusionsPatients with symptomatic Jackhammer without EGJOO benefit from POEM in long‐term follow‐up. Treatment of Jackhammer with EGJOO, however, remains challenging and probably requires full sphincter myotomy and future studies which should address the pathogenesis of this variant and alternative strategies.

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Clinical outcomes and safety of high-resolution manometry guided superficial partial circular muscle myotomy in per-oral endoscopic myotomy for Jackhammer esophagus: Two cases report

Cited by 4 publications

References 23 publications

A rare case of Jackhammer esophagus presenting with reflux-like symptoms in Guizhou, China

A rare case of Jackhammer esophagus presenting with reflux-like symptoms in Guizhou, China

Jackhammer Esophagus

Peroral endoscopic myotomy for hypercontractile (Jackhammer) esophagus: A retrospective multicenter series with long‐term follow‐up

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