Peroral Endoscopic Myotomy for Treatment of Achalasia: Initial Results of a Korean Study

Lee, Byung Hoo; Shim, Kwang Yeun; Hong, Su Jin; Bok, Gene Hyun; Cho, Jun-Hyung; Lee, Tae Hee; Cho, Joo Young

doi:10.5946/ce.2013.46.2.161

Cited by 73 publications

(36 citation statements)

References 21 publications

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“…18,19 Recently developed POEM is also effective in lowering LES pressure, but requires longer follow-up and needs to be compared with PD or surgical myotomy. 17,[20][21][22] The most popular protocol of PD is a graded dilatation starting with a 3.0 cm, followed by 3.5 cm and then 4.0 cm balloon, in subsequent sessions balloon. 23 In our institution, a single dilatation with a 3.0 cm balloon is performed as the initial treatment and additional PD is performed according to an "on demand" strategy, based on symptom recurrence during follow-up.…”

Section: Discussionmentioning

confidence: 99%

Association Between Gastroesophageal Reflux Disease After Pneumatic Balloon Dilatation and Clinical Course in Patients With Achalasia

Lee

et al. 2014

J Neurogastroenterol Motil

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Background/AimsThe occurrence of gastroesophageal reflux disease (GERD) is known to be associated with lower post-treatment lower esophageal sphincter pressure in patients with achalasia. This study aimed to elucidate whether GERD after pneumatic balloon dilatation (PD) has a prognostic role and to investigate how the clinical course of GERD is. MethodsA total of 79 consecutive patients who were first diagnosed with primary achalasia and underwent PD as an initial treatment were included in this retrospective study. Single PD was performed using a 3.0 cm balloon. The patients were divided into two groups: 1) who developed GERD after PD (GERD group) and 2) who did not develop GERD after PD (non-GERD group). GERD was defined as pathological acid exposure, reflux esophagitis or typical reflux symptoms. ResultsTwenty one patients (26.6%) developed GERD after PD during follow-up. There were no significant differences between the two groups in demographic or clinical factors including pre-and post-treatment manometric results. All patients in GERD group were well responsive to maintenance proton pump inhibitor therapy including on demand therapy or did not require maintenance. During a median follow-up of 17.8 months (interquartile range, 7.1-42.7 months), achalasia recurred in 15 patients (19.0%). However, the incidence of recurrence did not differ according to the occurrence of GERD after PD. ConclusionsGERD often occurs after even a single PD for achalasia. However, GERD after PD is well responsive to PPI therapy. Our data suggest that GERD after PD during follow-up does not appear to have a prognostic role.

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Section: Discussionmentioning

confidence: 99%

Association Between Gastroesophageal Reflux Disease After Pneumatic Balloon Dilatation and Clinical Course in Patients With Achalasia

Lee

et al. 2014

J Neurogastroenterol Motil

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“…6,7,[17][18][19][20][21][22][23][24] Previous studies demonstrated that the long-term benefits of surgical and endoscopic treatment of achalasia are directly related with the reduction of the basal LOS pressure. 4,5 Recurrences of dysphagia have been observed more frequently in case of LOS pressure !10 mmHg.…”

Section: Discussionmentioning

confidence: 99%

EndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy

et al. 2014

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Background: Peroral endoscopic myotomy (POEM) has been recently introduced in clinical practice for the treatment of achalasia. The endoluminal functional lumen imaging probe (EndoFLIP) system) uses impedance planimetry for the realtime measurement of the diameter of the oesophago-gastric junction. Objective: The aim of this study is to prospectively evaluate the effect of POEM on the oesophago-gastric junction using EndoFLIP. Methods: All the patients who underwent POEM in a single centre between April and July 2013 were enrolled in the study. EndoFLIP was used intraoperatively, immediately before and after POEM. During follow-up patients underwent oesophagogastroduodenoscopy, oesophageal pH monitoring and manometry. Clinical outcomes were compared with the diameter of the oesophago-gastric junction after POEM. Results: In total, 23 patients (12 males, mean age 51.7 years) were enrolled, and 21 underwent POEM successfully. Preoperative mean basal lower oesophageal sphincter pressure was 42.1 mmHg (AE17.6). Before POEM, the mean oesophago-gastric junction diameter and cross-sectional area were 6.3 mm (AE1.8) and 32.9 mm 2 (AE23.1), respectively. After treatment, the mean diameter and cross-sectional area of the oesophago-gastric junction were 11.3 mm (AE1.7 SD) and 102.38 mm 2 (AE28.2 SD), respectively. No complications occurred during a mean follow-up of 5 months. Median postoperative Eckardt score was 1. Three patients (14.3%) referred heartburn. Follow-up studies revealed gastro-oesophageal reflux disease (GORD) in 57.1% of patients and oesophagitis in 33.3%. No correlations were observed between the diameter of oesophago-gastric junction after POEM and symptoms relief, GORD incidence and lower oesophageal sphincter pressure. Conclusions: The diameter of oesophago-gastric junction substantially increases after POEM. EndoFLIP is a reliable method for the intraoperative evaluation of oesophago-gastric junction diameter. However, the real usefulness of this technology after POEM remains controversial.

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“…The new technique gained a wide popularity and has been enthusiastically embraced by the medical community (especially by interventional gastroenterologists with experience in operative oesophago-gastric endoscopy). As it is often seen when a new technique is introduced the potential for publication bias is at its greatest, and the early reports on POEM were extremely optimistic with almost no complications, rapid recovery and a good-result rate approaching 100% of treated patients (11)(12)(13)(14).…”

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confidence: 99%