Minimally invasive surgery for non-achalasia primary esophageal motility disorders is currently underused

Herbella, Fernando A. M.; Schlottmann, Francisco

doi:10.20517/2574-1225.2019.20

Cited by 2 publications

(3 citation statements)

References 15 publications

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“…Surgeons have been overly cautious in treating primary motility disorders apart from achalasia, particularly for functional obstruction at the level of the LES. 13 And while the number of reports of Heller's myotomy in EJGOO cases is very small, 14 we have witnessed 2 or 3 POEMs a week in our own institutions for EJGOO, mostly performed by gastroenterologists, with questionable indications and poor outcomes.…”

Section: Fernando Herbella and Marco Pattimentioning

confidence: 97%

How Changes in Treatment Guidelines Affect the Standard of Care: Ethical Opinions Using the Chicago 4.0 Classification for Esophageal Motility Disorders as Example

Herbella

Patti

Filho

et al. 2022

Foregut: The Journal of the American Foregut Society

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Background: Traditionally, guidelines issued by medical societies have provided a standard of care for the treatment of disease processes, establishing clear pathways, and limiting litigation. A major ethical dilemma may occur when an update in guidelines may lead to an instant change in the standard of care. Methods: We present a hypothetical clinical scenario of esophagogastric obstruction outflow obstruction (EGJOO) where guidelines were changed, and we asked the opinion of experts in different areas—surgeons, ethicists, and lawyers. Results: Each group of experts presented their opinion on ethical issues relevant to the clinical case. Conclusions: The clinical case presented and the guidelines for the treatment of primary esophageal motility disorders based on the Chicago classification 4.0, represent a current issue that the world of medicine has to face. While guidelines are usually particularly useful for practitioners, they must be based on irrevocable principles. They must be the result of a rigorous scientific analysis of available data by a group of real experts, and opinions should be avoided if not based on evidence. The level of evidence should be clearly stated, stressing the weakness of some recommendations when present. Conflicts of interest of the Authors of the guidelines should be not only declared, but carefully analyzed in order to avoid biases. Finally, radical changes in a short period of time should be avoided as they expose the practitioners to poor outcomes and litigation.

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Section: Fernando Herbella and Marco Pattimentioning

confidence: 97%

How Changes in Treatment Guidelines Affect the Standard of Care: Ethical Opinions Using the Chicago 4.0 Classification for Esophageal Motility Disorders as Example

Herbella

Patti

Filho

et al. 2022

Foregut: The Journal of the American Foregut Society

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“…Similar to EJGOO, Chicago 4.0 incorporated clinical evaluation to avoid overtreatment. Also parallel to EJGOO, POEM has been extensively indicated as treatment [34][35][36] while operative treatment (Heller's myotomy) is parsimoniously used in very selected cases [37].…”

Section: Distal Esophageal Spasmmentioning

confidence: 99%

“…Similar to other described PEMDs, POEM has been liberally used to treat hypercontractile esophagus [ 41 ] while surgery has been underused [ 37 ]. We showed that indications for surgery for nutcracker esophagus (probably most cases of nutcracker according to the conventional manometry classification correspond to hypercontractile esophagus) are the presence of obstructive symptoms and evidence of obstruction at the LES.…”

Section: Hypercontractile Esophagusmentioning

confidence: 99%

Changes in the Treatment of Primary Esophageal Motility Disorders Imposed by the New Classification for Esophageal Motility Disorders on High Resolution Manometry (Chicago Classification 4.0)

et al. 2021

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The Chicago Classification is the most used classification for primary esophageal motility disorders (PEMD). This classification was recently updated to the 4.0 version. This opinion piece focuses on the possible implications for the treatment of PMED determined by the new classification. Chicago Classification 4.0 included two new concepts for the diagnosis of achalasia: (1) type III achalasia diagnosis demands 100% absent peristalsis defined as either failed peristalsis or spasm; (2) ''inconclusive diagnosis of achalasia'' was added as a possibility. Both may decrease unnecessary treatment. Esophagogastric junction outflow obstruction, distal esophageal spasm, and hypercontractile esophagus were only considered clinically significant when correlated to supportive testing and relevant clinical symptoms and in the absence of gastroesophageal reflux disease. This may decrease the surge of treatment, especially peroral endoscopic myotomy, based solely on manometric diagnosis.

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Minimally invasive surgery for non-achalasia primary esophageal motility disorders is currently underused

Cited by 2 publications

References 15 publications

How Changes in Treatment Guidelines Affect the Standard of Care: Ethical Opinions Using the Chicago 4.0 Classification for Esophageal Motility Disorders as Example

How Changes in Treatment Guidelines Affect the Standard of Care: Ethical Opinions Using the Chicago 4.0 Classification for Esophageal Motility Disorders as Example

Changes in the Treatment of Primary Esophageal Motility Disorders Imposed by the New Classification for Esophageal Motility Disorders on High Resolution Manometry (Chicago Classification 4.0)

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