Pneumatic Dilation for Achalasia Cardia: Reduction in Lower Esophageal Sphincter Pressure in Assessing Response and Factors Associated With Recurrence During Long‐term Follow Up

Ghoshal, Uday C; Murali, Rangan; Misra, Asha

doi:10.1111/j.1443-1661.2011.01159.x

Cited by 32 publications

(30 citation statements)

References 33 publications

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“…Therapy instead is directed towards disrupting or weakening the LES. Diminution of LES pressure after therapy is paramount in attaining relief from dysphagia [5,6] . Until recently, the three traditional options for this were botulinum (Botox) injection (BTI) into the LES, pneumatic dilation (PD) of the LES and surgical myotomy (often with subsequent fundoplication to minimize reflux).…”

Section: Prior Conventional Treatments For Achalasiamentioning

confidence: 99%

Per-oral endoscopic myotomy for achalasia: An American perspective

Friedel

Modayil²,

Iqbal³

et al. 2013

WJGE

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Achalasia is an uncommon esophageal motility disorder characterized by the selective loss of enteric neurons leading to absence of peristalsis and impaired relaxation of the lower esophageal sphincter. Per-oral endoscopic myotomy (POEM) is a novel modality for the treatment of achalasia performed by gastroenterologists and surgeons. It represents a natural orifice transluminal endoscopic surgery (NOTES) approach to Heller myotomy. POEM has the minimal invasiveness of an endoscopic procedure that can duplicate results of the surgical Heller myotomy. POEM is conceptually similar to a surgical myotomy without the inherent external incisions and post-operative care associated with surgery. Initial high success and low complications rates promise a great future for this technique. In fact, POEM has been successfully performed on patients with end-stage achalasia as an initial treatment reserving esophagectomy for those without good response. The volume of POEMs performed worldwide has grown exponentially. In fact, surgeons who have performed Heller myotomy have embraced POEM as the preferred intervention for achalasia. However, the niche of POEM remains to be defined and long term results are awaited. We describe our experience with POEM having performed the first POEM outside of Japan in 2009, the evolution of our technique, and give our perspective on its future. Key words: Per-oral endoscopic myotomy; Achalasia; Heller myotomy; Natural orifice transluminal endoscopic surgery; Per-oral endoscopic myotomy; Minimally invasive surgery Core tip: Per-oral endoscopic myotomy (POEM) is a minimally invasive endoscopic procedure that duplicates results of the surgical Heller myotomy. This innovative technique has been performed by both gastroenterologists and surgeons. POEM has been shown to be safe and effective in patients with classic achalasia and modest follow-up data. POEM has also been successfully applied in patients with hypertensive esophageal motor disorders as well as end-stage achalasia. It is recommended that prior to performing POEM, operators should have experience in endoscopic submucosal dissection or substantial training in animal models.

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Section: Prior Conventional Treatments For Achalasiamentioning

confidence: 99%

Per-oral endoscopic myotomy for achalasia: An American perspective

Friedel

Modayil²,

Iqbal³

et al. 2013

WJGE

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“…The median LES pressure significantly decreased from 39.9 mmHg (28.7-50.3 mmHg) to 28.1 mmHg (17.6-34.9 mmHg) after PD. Ghoshal et al 35 have reported 22.5 mmHg as a best cut-off value of post-treatment LES pressure differentiating responders and non-responders after PD. However, among the current study patients, only 28 patients (43.9%) showed post-treatment LES pressure within 22.5 mmHg even though they all showed symptom improvement.…”

Section: Discussionmentioning

confidence: 99%

“…This discrepancy might stem from the different definitions used in the each study. In the study by Ghoshal et al, 35 response to PD was defined as a decrease in dysphagia score to 0 or 1 and/or total symptom score to ≤ 3 on follow-up visit after PD. However, we evaluated the symptom response by subjective satisfaction for symptom relief.…”

Section: Discussionmentioning

confidence: 99%

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

Ye¹,

Lee²,

Min³

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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“…Recent use of HRM has suggested that those with classic achalasia (predominant apersistalsis of distal esophagus -Chicago classification type I) and those with esophageal smooth muscle compression pattern on manometry (Chicago classification type II) respond much better to PD than those with so-called 'vigorous' achalasia or achalasia with high-pressure waves in the distal esophagus on HRM (Chicago classification type III) [Pretap et al 2011]. The absolute value of baseline LES pressure is not a predictive factor, but failure to lower the LES pressure significantly (usually to <10 mmHg) is associated with a poor outcome with PD [Hulselmans et al 2010;Ghoshal et al 2012].…”

Section: Pneumatic Dilationmentioning

confidence: 99%

Endoscopic approaches to treatment of achalasia

Stavropoulos

Friedel

Modayil

et al. 2012

Therap Adv Gastroenterol

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Endoscopic therapy for achalasia is directed at disrupting or weakening the lower esophageal sphincter (LES). The two most commonly utilized endoscopic interventions are large balloon pneumatic dilation (PD) and botulinum toxin injection (BTI). These interventions have been extensively scrutinized and compared with each other as well as with surgical disruption (myotomy) of the LES. PD is generally more effective in improving dysphagia in achalasia than BTI, with the latter reserved for infirm older people, and PD may approach treatment results attained with myotomy. However, PD may need to be repeated. Small balloon dilation and endoscopic stent placement for achalasia have only been used in select centers. Per oral endoscopic myotomy is a newer endoscopic modality that will likely change the treatment paradigm for achalasia. It arose from the field of natural orifice transluminal endoscopic surgery and represents a scarless endoscopic approach to Heller myotomy. This is a technique that requires extensive training and preparation and thus there should be rigorous accreditation and monitoring of outcomes to ensure safety and efficacy.

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Pneumatic Dilation for Achalasia Cardia: Reduction in Lower Esophageal Sphincter Pressure in Assessing Response and Factors Associated With Recurrence During Long‐term Follow Up

Cited by 32 publications

References 33 publications

Per-oral endoscopic myotomy for achalasia: An American perspective

Per-oral endoscopic myotomy for achalasia: An American perspective

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

Endoscopic approaches to treatment of achalasia

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