The treatment of achalasia patients with esophageal varices: an international study.
Aged
Botulinum Toxins
/ administration & dosage
Dilatation
/ statistics & numerical data
Esophageal Achalasia
/ complications
Esophageal Sphincter, Lower
/ drug effects
Esophageal and Gastric Varices
/ complications
Esophagoscopy
/ methods
Female
Follow-Up Studies
Heller Myotomy
/ statistics & numerical data
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Esophageal varices
achalasia treatment
botulinum toxin injection
peroral endoscopic myotomy
pneumatic dilation
Journal
United European gastroenterology journal
ISSN: 2050-6406
Titre abrégé: United European Gastroenterol J
Pays: England
ID NLM: 101606807
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
02
10
2018
accepted:
22
01
2019
entrez:
9
5
2019
pubmed:
9
5
2019
medline:
9
5
2019
Statut:
ppublish
Résumé
Treatment options for achalasia include endoscopic and surgical techniques that carry the risk of esophageal bleeding and perforation. The rare coexistence of esophageal varices has only been anecdotally described and treatment is presumed to carry additional risk. Experience from physicians/surgeons treating this rare combination of disorders was sought through the International Manometry Working Group. Fourteen patients with achalasia and varices from seven international centers were collected (mean age 61 ± 9 years). Five patients were treated with botulinum toxin injections (BTI), four had dilation, three received peroral endoscopic myotomy (POEM), one had POEM then dilation, and one patient underwent BTI followed by Heller's myotomy. Variceal eradication preceded achalasia treatment in three patients. All patients experienced a significant symptomatic improvement (median Eckardt score 7 vs 1; This study shows an excellent short-term symptomatic response in patients with esophageal achalasia and varices and demonstrates that the therapeutic outcomes and complications, other than transient encephalopathy in both patients who had a portosystemic shunt, did not differ to disease-matched patients without varices.
Sections du résumé
Background
Treatment options for achalasia include endoscopic and surgical techniques that carry the risk of esophageal bleeding and perforation. The rare coexistence of esophageal varices has only been anecdotally described and treatment is presumed to carry additional risk.
Methods
Experience from physicians/surgeons treating this rare combination of disorders was sought through the International Manometry Working Group.
Results
Fourteen patients with achalasia and varices from seven international centers were collected (mean age 61 ± 9 years). Five patients were treated with botulinum toxin injections (BTI), four had dilation, three received peroral endoscopic myotomy (POEM), one had POEM then dilation, and one patient underwent BTI followed by Heller's myotomy. Variceal eradication preceded achalasia treatment in three patients. All patients experienced a significant symptomatic improvement (median Eckardt score 7 vs 1;
Conclusion
This study shows an excellent short-term symptomatic response in patients with esophageal achalasia and varices and demonstrates that the therapeutic outcomes and complications, other than transient encephalopathy in both patients who had a portosystemic shunt, did not differ to disease-matched patients without varices.
Identifiants
pubmed: 31065374
doi: 10.1177/2050640619838114
pii: 10.1177_2050640619838114
pmc: PMC6488800
doi:
Substances chimiques
Botulinum Toxins
EC 3.4.24.69
Types de publication
Journal Article
Multicenter Study
Langues
eng
Pagination
565-572Références
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