Discordance between high-resolution manometry, esophagoscopy and contrast esophagogram in determining landmarks for per-oral endoscopic myotomy in spastic esophageal disorders: a word of caution.
Achalasia
Esophagography
Esophagoscopy
High-resolution manometry
Per-oral endoscopic myotomy
Spastic esophageal disorders
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
received:
29
05
2020
accepted:
29
09
2020
pubmed:
14
10
2020
medline:
25
2
2023
entrez:
13
10
2020
Statut:
ppublish
Résumé
Myotomy length for per-oral endoscopic myotomy (POEM) is standardized for type I and II achalasia. However, for type III achalasia, jackhammer esophagus, diffuse esophageal spasms and esophagogastric junction outflow obstruction, there is no standard. Determining myotomy length based on the high-pressure zone found during high-resolution manometry (HRM) and spastic length found during esophagography may be used to determine adequate myotomy length without excess muscle destruction. The records of patients who have undergone POEM procedures at our institution had the following data gleaned: age, sex, esophageal spastic diagnosis, length of high-pressure zone and lower esophageal sphincter (LES) position by HRM, length of spastic esophagus by esophagography, position of the z-line by esophagoscopy and length of myotomy performed. Outcomes were assessed based on patient symptomatic improvement and need for re-intervention. 71 patients were evaluated for POEM, with 67 completing POEM. There was an average difference in LES position by HRM and z-line position by esophagoscopy of 3.9 ± 3.0 cm. There was an average difference in high-pressure zone by HRM and spastic length by esophagography of 4.9 ± 3.2 cm. Overall, with a median of 20 months follow-up, 74% achieved long-term symptomatic improvement, with 17 patients requiring re-intervention. Discordance among HRM, esophagography and esophagoscopy can be significant. Caution should be employed with using these methods to determine myotomy length in POEM.
Sections du résumé
BACKGROUND
Myotomy length for per-oral endoscopic myotomy (POEM) is standardized for type I and II achalasia. However, for type III achalasia, jackhammer esophagus, diffuse esophageal spasms and esophagogastric junction outflow obstruction, there is no standard. Determining myotomy length based on the high-pressure zone found during high-resolution manometry (HRM) and spastic length found during esophagography may be used to determine adequate myotomy length without excess muscle destruction.
METHODS
The records of patients who have undergone POEM procedures at our institution had the following data gleaned: age, sex, esophageal spastic diagnosis, length of high-pressure zone and lower esophageal sphincter (LES) position by HRM, length of spastic esophagus by esophagography, position of the z-line by esophagoscopy and length of myotomy performed. Outcomes were assessed based on patient symptomatic improvement and need for re-intervention.
RESULTS
71 patients were evaluated for POEM, with 67 completing POEM. There was an average difference in LES position by HRM and z-line position by esophagoscopy of 3.9 ± 3.0 cm. There was an average difference in high-pressure zone by HRM and spastic length by esophagography of 4.9 ± 3.2 cm. Overall, with a median of 20 months follow-up, 74% achieved long-term symptomatic improvement, with 17 patients requiring re-intervention.
CONCLUSIONS
Discordance among HRM, esophagography and esophagoscopy can be significant. Caution should be employed with using these methods to determine myotomy length in POEM.
Identifiants
pubmed: 33048228
doi: 10.1007/s00464-020-08064-8
pii: 10.1007/s00464-020-08064-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5613-5619Informations de copyright
© 2020. Springer Science+Business Media, LLC, part of Springer Nature.
Références
Kahrilas PJ, Bredenoord AJ, Carlson DA, Pandolfino JE (2018) Advances in management of esophageal motility disorders. Clin Gastroenterol Hepatol 16:1692–1700
doi: 10.1016/j.cgh.2018.04.026
Teitelbaum EN, Dunst CM (2019) High-resolution esophageal manometry: Techniques and use in the diagnosis of esophageal motility disorders and surgical decision-making. In: Yeo CJ (ed) Shackelford’s Surgery of the Alimentary Tract, 8th edn. Elsevier, Philadelphia
Kostic SV, Rice TW, Baker ME et al (2000) Timed barium esophagogram: a simple physiologic assessment for achalasia. J Thorac Cardiovasc Surg 120:935–943
doi: 10.1067/mtc.2000.110463
Auyang ED, Hungness ES (2019) Peroral endoscopic myotomy for achalasia and endoluminal approaches for GERD. In: Fischer JE (ed) Fisther’s Master of Surgery, 7th edn. Wolters Kluwer, Philadelphia
Inoue H, Sato H, Ikeda H et al (2015) Peroral endoscopic myotomy: A series of 500 patients. J Am Coll Surg 221:256–264
doi: 10.1016/j.jamcollsurg.2015.03.057
Benedict JJ, Golas AA, Richter JE, Velanovich V (2017) Health-related quality of life and physiological outcomes of peroral endoscopic myotomy for achalasia. J Laparoendosc Adv Surg Tech A 27:778–783
doi: 10.1089/lap.2017.0087
Akintoye E, Kumar N, Obaitan I et al (2016) Peroral endoscopic myotomy: a meta-analysis. Endoscopy 48:1059–1068
doi: 10.1055/s-0042-114426
Khan MA, Kumbhari V, Ngamruengphong S et al (2017) Is POEM the answer for management of spastic esophageal disorders? a systematic review and meta-analysis. Dig Dis Sci 62:35–44
doi: 10.1007/s10620-016-4373-1
Khashab MA, Familiari P, Draganov PV et al (2018) PerOral Endoscopic Myotomy is effective and safe in non-achalasia esophageal motility disorders including spastic esophageal disease and esophagogastric junction outflow obstruction an international multicenter study. Endosc Int Open 6(8):E1031–1036
doi: 10.1055/a-0625-6288
Sharata AM, Dunst CM, Pescarus R et al (2015) Peroral endoscopic myotomy (POEM) for esophageal primary motility disorders: analysis of 100 consecutive patients. J Gastrointest Surg 19:161–170
doi: 10.1007/s11605-014-2610-5
Parsa N, Khashab MA (2018) Peroral endoscopic myotomy (POEM) for esophageal motility disorders other than achalasia. Tech Gastrointest Endosc 20:120–124
doi: 10.1016/j.tgie.2018.08.001
Hoppo T, Thakkar SJ, Schumacher LY et al (2016) Utility of peroral endoscopic myotomy (POEM) across the spectrum of esophageal motility disorders. Surg Endosc 30:233–244
doi: 10.1007/s00464-015-4193-y
Kane ED, Budhraja V, Desilets DJ, Romanelli JR (2019) Myotomy length informed by high-resolution esophageal manometry (HREM) results in improved per-oral endoscopic myotomy (POEM) outcomes for type III achalasia. Surg Endosc 33:886–894
doi: 10.1007/s00464-018-6356-0
Triantafyllou T, Theodoropoulos C, Georgiou G et al (2019) Long-term outcome of myotomy and fundoplication based on intraoperative real-time high-resolution manometry in achalasia patients. Ann Gastroenterol 32:46–51
pubmed: 30598591
Su B, Callahan ZM, Novak S et al (2020) Using impedance planimetry (Endoflip) to evaluate myotomy and predict outcomes after surgery for achalasia. J Gastrointest Surg 24:964–971
doi: 10.1007/s11605-020-04513-w
Weche M, Saad A, Richter JE et al (2020) Revisional procedures for recurrent symptoms after Heller myotomy and per-oral endoscopic myotomy. J Laparoendosc Surg Adv Surg Tech A 30:110–116
doi: 10.1089/lap.2019.0277
Smith K, Saad AR, Hanna JP et al (2020) Revisional surgery in patients with recurrent dysphagia after Heller myotomy. J Gastrointest Surg 24:991–999
doi: 10.1007/s11605-019-04264-3