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Experience with Peroral Endoscopic Myotomy for Achalasia and Spastic Esophageal Motility Disorders at a Tertiary U.S. Center

Clinical Endoscopy 2020년 53권 3호 p.321 ~ 327
Masadeh Maen, Nau Peter, Chandra Subhash, Klair Jagpal, Keech John, Parekh Kalpaj R., El Abiad Rami, Gerke Henning,
소속 상세정보
 ( Masadeh Maen ) - University of Iowa Hospitals and Clinics Division of Gastroenterology and Hepatology
 ( Nau Peter ) - University of Iowa Hospitals and Clinics Division of Minimally Invasive and Bariatric Surgery
 ( Chandra Subhash ) - University of Iowa Hospitals and Clinics Division of Gastroenterology and Hepatology
 ( Klair Jagpal ) - University of Iowa Hospitals and Clinics Division of Gastroenterology and Hepatology
 ( Keech John ) - University of Iowa Hospitals and Clinics Division of Thoracic Surgery
 ( Parekh Kalpaj R. ) - University of Iowa Hospitals and Clinics Division of Thoracic Surgery
 ( El Abiad Rami ) - University of Iowa Hospitals and Clinics Division of Gastroenterology and Hepatology
 ( Gerke Henning ) - University of Iowa Hospitals and Clinics Division of Gastroenterology and Hepatology

Abstract


Background/Aims: Peroral endoscopic myotomy (POEM) is a novel procedure for the treatment of achalasia and spastic esophageal disorders. Experience with POEM is limited, but its reported outcomes are excellent. It is deemed safe even for patients with prior interventions.

Methods: This retrospective review included patients who underwent POEM at a tertiary US center. POEM was performed in a multidisciplinary approach by advanced endoscopists and foregut surgeons. Clinical success was defined as a post-POEM Eckardt score ≤3.

Results: A total of 125 patients were included. Median follow-up period was 18 months (interquartile range, 10?22 months). Clinical success was achieved in 92% of patients and persisted at 12 months in 88% of patients. Mucosal barrier failure (MBF) occurred in 7 patients, 2 of whom required surgical intervention. MBF was more common in patients with prior laparoscopic Heller myotomy (19% vs. 3%, p=0.015). MBF requiring surgical intervention occurred early in the learning curve.

Conclusions: POEM is safe and effective in the treatment of achalasia and spastic esophageal disorders even after failed prior interventions.

키워드

Achalasia; Dysphagia; Eckardt score; Peroral endoscopic myotomy

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