Intraoperative high-resolution esophageal manometry during peroral endoscopic myotomy.
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
26 08 2020
26 08 2020
Historique:
received:
24
01
2020
accepted:
10
08
2020
entrez:
28
8
2020
pubmed:
28
8
2020
medline:
6
3
2021
Statut:
epublish
Résumé
Peroral endoscopic myotomy is an accepted treatment of achalasia. Some of the treatment failures can be attributable to an insufficient length of the myotomy on the gastric side, because of a more technically challenging submucosal dissection. We assessed the feasibility and the impact of an intraoperative esophageal manometry during the peroral endoscopic myotomy procedure. A high-resolution manometry catheter was introduced through the nostril before the endoscope, and left in place during the peroral endoscopic myotomy procedure. The lower esophageal sphincter pressure was recorded throughout the peroral endoscopic myotomy. The myotomy was extended on the gastric side until the lower esophageal sphincter pressure dropped below 10 mmHg. We included 10 patients (mean age = 55 years old, 3 men) treated by peroral endoscopic myotomy for type I (3/10), type II (3/10), type III achalasia (3/10) or esophagogastric junction outflow obstruction (1/10). Manometric recording was possible in all patients. The median (IQR) lower esophageal sphincter resting pressure was 23 (17-37) mmHg before myotomy, 15 (13-19) mmHg at the end of the tunnel, and 7 (6-11) mmHg at the end of the myotomy. In 4 patients out of 10, the myotomy was extended on the base of the intraoperative manometry findings. High-resolution esophageal manometry is feasible during the peroral endoscopic myotomy procedure, and leads to increase the length of the gastric myotomy in 4 out of 10 patients. However, the cumbersome nature of intraoperative high-resolution manometry during peroral endoscopic myotomy and the high frequency of gastro-esophageal reflux disease after extended gastric myotomy suggest to limit this technique to selected patients refractory to a first myotomy.
Identifiants
pubmed: 32848175
doi: 10.1038/s41598-020-71136-1
pii: 10.1038/s41598-020-71136-1
pmc: PMC7450054
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
14198Références
Inoue, H. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42, 265–271 (2010).
doi: 10.1055/s-0029-1244080
Kahrilas, P. J., Katzka, D. & Richter, J. E. Clinical practice update: the use of per-oral endoscopic myotomy in achalasia: expert review and best practice advice from the AGA Institute. Gastroenterology 153, 1205–1211 (2017).
doi: 10.1053/j.gastro.2017.10.001
Werner, Y. B. et al. Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut 65, 899–906 (2016).
doi: 10.1136/gutjnl-2014-308649
Werner, Y. B. et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. N. Engl. J. Med. 381, 2219–2229 (2019).
doi: 10.1056/NEJMoa1905380
Liu, Z. et al. Comprehensive evaluation of the learning curve for peroral endoscopic myotomy. Clin. Gastroenterol. Hepatol. 16, 1420-1426.e2 (2018).
doi: 10.1016/j.cgh.2017.11.048
Del Genio, A. et al. Intraoperative esophageal manometry: our experience. Dis. Esophagus 10, 253–261 (1997).
doi: 10.1093/dote/10.4.253
Corcione, F. et al. Surgical laparoscopy with intraoperative manometry in the treatment of esophageal achalasia. Surg. Laparosc. Endosc. 7, 232–235 (1997).
doi: 10.1097/00019509-199706000-00011
Familiari, P. et al. EndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy. United Eur. Gastroenterol J 2, 77–83 (2014).
doi: 10.1177/2050640614521193
Teitelbaum, E. N. et al. The effect of incremental distal gastric myotomy lengths on EGJ distensibility during POEM for achalasia. Surg. Endosc. 30, 745–750 (2016).
doi: 10.1007/s00464-015-4269-8
Goong, H. J., Hong, S. J. & Kim, S. H. Intraoperative use of a functional lumen imaging probe during peroral endoscopic myotomy in patients with achalasia: a single-institute experience and systematic review. PLoS ONE 15, e0234295 (2020).
doi: 10.1371/journal.pone.0234295
Wu, P. I. et al. Novel intra-procedural distensibility measurement accurately predicts immediate outcome of pneumatic dilatation for idiopathic achalasia. Am. J. Gastroenterol. 113, 205–212 (2018).
doi: 10.1038/ajg.2017.411
Eckardt, V. F., Gockel, I. & Bernhard, G. Pneumatic dilation for achalasia: late results of a prospective follow up investigation. Gut 53, 629–633 (2004).
doi: 10.1136/gut.2003.029298
Inoue, H. et al. Per-oral endoscopic myotomy: a series of 500 patients. J. Am. Coll. Surg. 221, 256–264 (2015).
doi: 10.1016/j.jamcollsurg.2015.03.057
Liu, X.-Y. et al. A risk-scoring system to predict clinical failure for patients with achalasia after peroral endoscopic myotomy. Gastrointest. Endosc. 91, 33-40.e1 (2020).
doi: 10.1016/j.gie.2019.07.036
Tanaka, S. et al. Novel per-oral endoscopic myotomy method preserving oblique muscle using two penetrating vessels as anatomic landmarks reduces postoperative gastroesophageal reflux. J. Gastroenterol. Hepatol. 34, 2158–2163 (2019).
doi: 10.1111/jgh.14814