Morphologic Restoration After Peroral Endoscopic Myotomy in Sigmoid-type Achalasia.
Esophageal achalasia
Myotomy
Peroral endoscopic myotomy
Sigmoid-type achalasia
Journal
Journal of neurogastroenterology and motility
ISSN: 2093-0879
Titre abrégé: J Neurogastroenterol Motil
Pays: Korea (South)
ID NLM: 101530189
Informations de publication
Date de publication:
30 Jan 2020
30 Jan 2020
Historique:
received:
29
07
2019
revised:
17
10
2019
accepted:
25
11
2019
pubmed:
24
12
2019
medline:
24
12
2019
entrez:
24
12
2019
Statut:
ppublish
Résumé
Achalasia is a chronic, progressive motility disorder of the esophagus. The sigmoid-type achalasia is an advanced stage of achalasia characterized by severe dilatation and tortuous angulation of the esophageal body. Peroral endoscopic myotomy (POEM) has been reported to provide excellent clinical outcomes for achalasia, including the sigmoid type, but the restoration of esophageal morphology and function remain poorly described. The aim of our study is to investigate esophageal restoration after POEM for sigmoid-type achalasia. From 98 patients with achalasia who underwent POEM in the Yonsei University Health System from 2013 to 2018, we recruited 13 patients with sigmoid-type achalasia (7 male; mean age 53.3 years) and assessed morphological and manometric changes in the esophagus. Clinical success (Eckardt score < 3) was achieved in all cases. After POEM, the average angle of esophageal tortuosity became more obtuse (91.5° vs 114.6°, POEM resulted in excellent clinical outcomes and morphologic improvement in sigmoid-type achalasia. These results suggest that the improvement of esophageal tortuosity through POEM reflects a reduced esophageal burden.
Sections du résumé
BACKGROUND/AIMS
OBJECTIVE
Achalasia is a chronic, progressive motility disorder of the esophagus. The sigmoid-type achalasia is an advanced stage of achalasia characterized by severe dilatation and tortuous angulation of the esophageal body. Peroral endoscopic myotomy (POEM) has been reported to provide excellent clinical outcomes for achalasia, including the sigmoid type, but the restoration of esophageal morphology and function remain poorly described. The aim of our study is to investigate esophageal restoration after POEM for sigmoid-type achalasia.
METHODS
METHODS
From 98 patients with achalasia who underwent POEM in the Yonsei University Health System from 2013 to 2018, we recruited 13 patients with sigmoid-type achalasia (7 male; mean age 53.3 years) and assessed morphological and manometric changes in the esophagus.
RESULTS
RESULTS
Clinical success (Eckardt score < 3) was achieved in all cases. After POEM, the average angle of esophageal tortuosity became more obtuse (91.5° vs 114.6°,
CONCLUSIONS
CONCLUSIONS
POEM resulted in excellent clinical outcomes and morphologic improvement in sigmoid-type achalasia. These results suggest that the improvement of esophageal tortuosity through POEM reflects a reduced esophageal burden.
Identifiants
pubmed: 31869868
pii: jnm19144
doi: 10.5056/jnm19144
pmc: PMC6955197
doi:
Types de publication
Journal Article
Langues
eng
Pagination
67-73Références
Neurogastroenterol Motil. 2015 Feb;27(2):160-74
pubmed: 25469569
Eur J Gastroenterol Hepatol. 2016 Jan;28(1):30-6
pubmed: 26473299
Am Surg. 2007 Apr;73(4):327-31
pubmed: 17439022
Interact Cardiovasc Thorac Surg. 2013 Jan;16(1):49-54
pubmed: 23065746
Ann Thorac Surg. 2001 Sep;72(3):854-8
pubmed: 11565670
Can J Physiol Pharmacol. 2005 Oct;83(10):923-31
pubmed: 16333364
Hepatogastroenterology. 1996 May-Jun;43(9):492-500
pubmed: 8799383
J Gastroenterol Hepatol. 2016 Aug;31(8):1422-8
pubmed: 27060999
Surg Endosc. 2015 Sep;29(9):2841-50
pubmed: 25492452
Esophagus. 2017;14(4):275-289
pubmed: 28983228
PLoS One. 2017 May 23;12(5):e0178414
pubmed: 28542509
World J Gastroenterol. 2015 May 14;21(18):5622-9
pubmed: 25987787
J Physiol. 1966 May;184(1):170-92
pubmed: 5921536
World J Gastroenterol. 2016 May 28;22(20):4918-25
pubmed: 27239118
World J Gastroenterol. 2013 Sep 21;19(35):5806-12
pubmed: 24124325
Int J Surg. 2011;9(3):204-8
pubmed: 21111851
J Cell Sci. 2005 Jun 1;118(Pt 11):2381-92
pubmed: 15923651
Endoscopy. 2010 Apr;42(4):265-71
pubmed: 20354937
J Gastroenterol. 2016 May;51(5):458-64
pubmed: 26498923
Nat Rev Gastroenterol Hepatol. 2015 Jul;12(7):410-26
pubmed: 26035678
J Am Coll Surg. 1999 Aug;189(2):158-63
pubmed: 10437837
Gastrointest Endosc Clin N Am. 2001 Apr;11(2):235-48, v
pubmed: 11319059
J Neurogastroenterol Motil. 2016 Jan 31;22(1):14-24
pubmed: 26717928