Efficacy of per-oral endoscopic myotomy for the treatment of non-achalasia esophageal motor disorders

Bernardot, Lucie; Roman, Sabine; Barret, Maximilien; Vitton, Véronique; Wallenhorst, Timothée; Pioche, Mathieu; Chaussade, Stanislas; Gonzalez, Jean‐Michel; Ponchon, Thierry; Prat, Frédéric; Barthet, Marc; Vergniol, Julien; Chabrun, Edouard; Zerbib, Frank

doi:10.1007/s00464-019-07348-y

Cited by 42 publications

(49 citation statements)

References 13 publications

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“…Surprisingly, in this study, 3 out of 10 patients who did not receive any treatment had a favorable evolution of hypercontractile esophagus, including one with JE 26 ; this could be due to a placebo effect or to the spontaneous evolution of the disease. Regarding POEM, two recent multicenter retrospective studies demonstrated the efficacy of this technique in patients with a spastic motor disorder of the esophagus, including patients with JE, refractory to medical treatment, 13,15 and a recent meta‐analysis also confirmed these results 14 . However, the efficacy of treatments reported in these studies should be moderated, as symptoms in patients with hypercontractile esophagus may improve spontaneously over time 27 …”

Section: Discussionmentioning

confidence: 93%

“…More recently, the efficacy of per-oral endoscopic myotomy (POEM) has been reported in some patients. [13][14][15] The objective of this multicenter retrospective study was to report the clinical and manometric characteristics in a large multicenter cohort of JE patients and to evaluate the proposed treatments and their efficacy.…”

Section: Introductionmentioning

confidence: 99%

“…As during other spastic disorders of the esophagus, mainly achalasia, endoscopic treatments (botulinum toxin injection and endoscopic dilation) could be useful, but their efficacy has not been reported in JE patients. More recently, the efficacy of per‐oral endoscopic myotomy (POEM) has been reported in some patients 13–15 …”

Section: Introductionmentioning

confidence: 99%

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Jackhammer esophagus: Clinical presentation, manometric diagnosis, and therapeutic results—Results from a multicenter French cohort

Philonenko

Roman

Zerbib

et al. 2020

Neurogastroenterology Motil

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Background/aims: Jackhammer esophagus (JE) is a hypercontractile esophageal motor disorder defined by at least two swallows with a distal contractile integral (DCI) >8000 mm Hg.s.cm during high-resolution manometry (HRM). The relationship between symptoms and hypercontractility and the response to therapies have been poorly evaluated. The aim of this study was to determine the clinical presentation, manometric diagnosis, and therapeutic results in a large cohort of JE patients. Methods: Patients with JE diagnosed among the HRM tests performed in nine academic French centers from 01/01/2010 to 08/31/2016 were included. Patient charts were reviewed to collect clinical and therapeutic data. Results: Among the 16 264 HRM tests performed during this period, 227 patients (60.8 ± 13.8 years, 151 male) had JE (1.7%). Dysphagia was the most frequent symptom (74.6%), followed by regurgitation (37.1%) and chest pain (36.6%); 4.7% of the patients were asymptomatic. The diagnostic workup was heterogeneous, and only a minority of patients had esophageal biopsies. None of the individual symptoms were significantly associated with any of the manometric parameters defined, except for dysphagia, which was significantly associated with the mean of all DCIs >8000 mm Hg.s.cm (P = .04). Additionally, the number of symptoms was not associated with any manometric parameter. Medical treatment and endoscopic treatments had poor efficacy and a high relapse rate. Conclusion: Jackhammer esophagus is a rare motility disorder. Diagnostic workup is heterogeneous and should be standardized. Symptoms are poorly associated with manometric parameters. The medical treatments and endoscopic therapies currently used are inefficient.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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Jackhammer esophagus: Clinical presentation, manometric diagnosis, and therapeutic results—Results from a multicenter French cohort

Philonenko

Roman

Zerbib

et al. 2020

Neurogastroenterology Motil

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“…Its short-term curative efficacy is reported to be 90%-100%, with a longterm follow-up success rate of over 80% (Table 4). 9,13,16,17,28,29,[32][33][34][35][36][37][38][39][40][41][42][43][44][45] Also, compared with conventional achalasia treatments such as laparoscopic Heller myotomy and pneumatic dilatation, POEM had better clinical outcomes (Table 5). 30,38,[46][47][48][49][50] A me-ta-analysis comparing POEM (5,834 patients) and Heller myotomy (1,958 patients) showed that the clinical symptom remission rates at 1 year and 2 years after POEM were higher than those after Heller myotomy (1 year: 93.5% vs. 91.0%, p=0.01, 2 years: 92.7% vs. 90.0%, p=0.01).…”

Section: Clinical Outcomes Achalasiamentioning

confidence: 99%

Peroral Endoscopic Myotomy for Esophageal Motility Disorders

Kim

2020

Clin Endosc

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Peroral endoscopic myotomy (POEM) is one of the most clinically successful tunnel-based minimally invasive endoscopic treatments. The classic indications of POEM include achalasia of all types, including failed prior treatments, and expanded indications include the non-achalasia esophageal motility disorders, such as esophagogastric junction outflow obstruction, diffuse esophageal spasm, and jackhammer esophagus. For achalasia treatment, POEM has achieved a comparable surgical efficacy and a safety outcome and, therefore, has emerged as a first-line treatment. For non-achalasia esophageal motility disorders, POEM has also shown high clinical response rates. The complication rate of POEM for esophageal motility disorders is low and most complications are managed with conservative treatment. Currently, POEM is a representative procedure of natural orifice transluminal endoscopic surgery, which has shown a good clinical efficacy with low complication rates for esophageal motility disorders including achalasia. However, further studies are needed to treat non-achalasia motility disorder via POEM.

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“…Subsequent repeat POEM including the LES resulted in symptom resolution. In a recent publication, Bernardot et al reported on the efficacy of POEM in 30 patients with non‐achalasia esophageal motor disorders, 13 of whom had HE, the other 17 patients were diagnosed with nutcracker esophagus or DES 31 …”

Section: Treatmentmentioning

confidence: 99%