Complications after Heller myotomy in children: a national multicenter study on the impact of prior endoscopic dilatation and identification of risk factors.
Endoscopic dilation
Esocardiomyotomy
Minimally invasive surgery
Pediatric surgery
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
20 May 2024
20 May 2024
Historique:
received:
08
02
2024
accepted:
28
04
2024
medline:
21
5
2024
pubmed:
21
5
2024
entrez:
20
5
2024
Statut:
aheadofprint
Résumé
Although esophageal achalasia has been historically treated by Heller myotomy, endoscopic esophageal dilatations are nowadays often the first-line treatment in children. The aim was to assess whether performing an endoscopic dilatation before a Heller myotomy is associated with higher risks of esophageal perforation in children. A retrospective multicentric study was performed, including children that underwent a Heller myotomy (2000-2022, 10 centers). Two groups were compared based on the history of previous dilatation before myotomy. Outcomes esophageal perforation (intra-operative or secondary) and post-operative complications requiring surgery (Clavien-Dindo III). Statistics Comparisons using contingency tables or Kruskal-Wallis when appropriate. Statistical significance: p-value < 0.05. A Heller myotomy was performed in 77 children (median age: 11.8 years), with prior endoscopic dilatation in 53% (n = 41). A laparoscopic approach was used in 90%, with associated fundoplication in 95%. Esophageal perforation occurred in 19% of children (n = 15), including 12 patients with intra-operative mucosal tear and 3 with post-operative complications related to an unnoticed esophageal perforation. Previous endoscopic dilatation did not increase the risk of esophageal perforation (22% vs 17%, OR: 1.4, 95%CI: 0.43-4.69). Post-operative complications occurred in 8% (n = 6), with similar rates regardless of prior endoscopic dilatation. Intra-operative mucosal tear was the only risk factor for post-operative complications, increasing the risk of complications from 5 to 25% (OR: 6.89, 95%CI: 1.38-31.87). Prior endoscopic dilatations did not increase the risk of esophageal perforation or postoperative complications of Heller myotomy in this cohort of children with achalasia. Mucosal tear was identified as a risk factor for post-operative complications.
Sections du résumé
BACKGROUND
BACKGROUND
Although esophageal achalasia has been historically treated by Heller myotomy, endoscopic esophageal dilatations are nowadays often the first-line treatment in children. The aim was to assess whether performing an endoscopic dilatation before a Heller myotomy is associated with higher risks of esophageal perforation in children.
METHODS
METHODS
A retrospective multicentric study was performed, including children that underwent a Heller myotomy (2000-2022, 10 centers). Two groups were compared based on the history of previous dilatation before myotomy. Outcomes esophageal perforation (intra-operative or secondary) and post-operative complications requiring surgery (Clavien-Dindo III). Statistics Comparisons using contingency tables or Kruskal-Wallis when appropriate. Statistical significance: p-value < 0.05.
RESULTS
RESULTS
A Heller myotomy was performed in 77 children (median age: 11.8 years), with prior endoscopic dilatation in 53% (n = 41). A laparoscopic approach was used in 90%, with associated fundoplication in 95%. Esophageal perforation occurred in 19% of children (n = 15), including 12 patients with intra-operative mucosal tear and 3 with post-operative complications related to an unnoticed esophageal perforation. Previous endoscopic dilatation did not increase the risk of esophageal perforation (22% vs 17%, OR: 1.4, 95%CI: 0.43-4.69). Post-operative complications occurred in 8% (n = 6), with similar rates regardless of prior endoscopic dilatation. Intra-operative mucosal tear was the only risk factor for post-operative complications, increasing the risk of complications from 5 to 25% (OR: 6.89, 95%CI: 1.38-31.87).
CONCLUSIONS
CONCLUSIONS
Prior endoscopic dilatations did not increase the risk of esophageal perforation or postoperative complications of Heller myotomy in this cohort of children with achalasia. Mucosal tear was identified as a risk factor for post-operative complications.
Identifiants
pubmed: 38769183
doi: 10.1007/s00464-024-10884-x
pii: 10.1007/s00464-024-10884-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Savarino E, Bhatia S, Roman S, Sifrim D, Tack J, Thompson SK, Gyawali CP (2022) Achalasia. Nat Rev Dis Prim. https://doi.org/10.1038/S41572-022-00356-8
doi: 10.1038/S41572-022-00356-8
pubmed: 35513420
Islam S (2017) Achalasia. Semin Pediatr Surg 26:116–120. https://doi.org/10.1053/J.SEMPEDSURG.2017.02.001
doi: 10.1053/J.SEMPEDSURG.2017.02.001
pubmed: 28550869
Payne WS (1989) Heller’s contribution to the surgical treatment of achalasia of the esophagus. 1914. Ann Thorac Surg 48:876–881. https://doi.org/10.1016/0003-4975(89)90695-4
doi: 10.1016/0003-4975(89)90695-4
pubmed: 2688583
Goneidy A, Cory-Wright J, Zhu L, Malakounides G (2020) Surgical management of esophageal achalasia in pediatrics: a systematic review. Eur J Pediatr Surg 30:13–20. https://doi.org/10.1055/S-0039-1697958
doi: 10.1055/S-0039-1697958
pubmed: 31600801
Esposito C, Mendoza-Sagaon M, Roblot-Maigret B, Amici G, Desruelle P, Montupet P (2000) Complications of laparoscopic treatment of esophageal achalasia in children. J Pediatr Surg 35:680–683. https://doi.org/10.1053/JPSU.2000.5942
doi: 10.1053/JPSU.2000.5942
pubmed: 10813322
Nakayama DK, Shorter NA, Boyle JT, Watkins JB, O’Neill JA (1987) Pneumatic dilatation and operative treatment of achalasia in children. J Pediatr Surg 22:619–622. https://doi.org/10.1016/S0022-3468(87)80112-4
doi: 10.1016/S0022-3468(87)80112-4
pubmed: 3612456
Hung Y-C, Westfal ML, Chang DC, Kelleher CM (2019) Heller myotomy is the optimal index procedure for esophageal achalasia in adolescents and young adults. Surg Endosc 33:3355–3360. https://doi.org/10.1007/S00464-018-06625-6
doi: 10.1007/S00464-018-06625-6
pubmed: 30552502
Tashiro J, Petrosyan M, Kane TD (2021) Current management of pediatric achalasia. Transl Gastroenterol Hepatol. https://doi.org/10.21037/TGH-20-215
doi: 10.21037/TGH-20-215
pubmed: 34423154
pmcid: 8343414
Mencin AA, Sethi A, Barakat MT, Lerner DG (2022) Peroral endoscopic myotomy (POEM) in children: a state of the art review. J Pediatr Gastroenterol Nutr 75:231–236. https://doi.org/10.1097/MPG.0000000000003503
doi: 10.1097/MPG.0000000000003503
pubmed: 35653433
van Lennep M, van Wijk MP, Omari TIM, Benninga MA, Singendonk MMJ (2018) Clinical management of pediatric achalasia. Expert Rev Gastroenterol Hepatol 12:391–404. https://doi.org/10.1080/17474124.2018.1441023
doi: 10.1080/17474124.2018.1441023
pubmed: 29439587
Tsuboi K, Omura N, Yano F, Hoshino M, Yamamoto SR, Akimoto S, Masuda T, Kashiwagi H, Yanaga K (2018) Effect of preoperative balloon dilation on treatment outcomes of laparoscopic Heller-dor surgery for achalasia: a propensity score matched study. Surg Today 48:1068–1075. https://doi.org/10.1007/S00595-018-1695-Y
doi: 10.1007/S00595-018-1695-Y
pubmed: 30014216
Tsuboi K, Omura N, Yano F, Hoshino M, Yamamoto SR, Akimoto S, Masuda T, Kashiwagi H, Yanaga K (2016) Identification of risk factors for mucosal injury during laparoscopic Heller myotomy for achalasia. Surg Endosc 30:706–714. https://doi.org/10.1007/S00464-015-4264-0
doi: 10.1007/S00464-015-4264-0
pubmed: 26092001
Morino M, Rebecchi F, Festa V, Garrone C (1997) Preoperative pneumatic dilatation represents a risk factor for laparoscopic Heller myotomy. Surg Endosc 11:359–361. https://doi.org/10.1007/S004649900363
doi: 10.1007/S004649900363
pubmed: 9094277
Souma Y, Nakajima K, Taniguchi E, Takahashi T, Kurokawa Y, Yamasaki M, Miyazaki Y, Makino T, Hamada T, Yasuda J, Yumiba T, Ohashi S, Takiguchi S, Mori M, Doki Y (2017) Mucosal perforation during laparoscopic surgery for achalasia: impact of preoperative pneumatic balloon dilation. Surg Endosc 31:1427–1435. https://doi.org/10.1007/S00464-016-5133-1
doi: 10.1007/S00464-016-5133-1
pubmed: 27501729
Eckardt VF, Aignherr C, Bernhard G (1992) Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 103:1732–1738. https://doi.org/10.1016/0016-5085(92)91428-7
doi: 10.1016/0016-5085(92)91428-7
pubmed: 1451966
Clavien PA, Barkun J, De Oliveira ML, Vauthey JN, Dindo D, Schulick RD, De Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The clavien-dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196. https://doi.org/10.1097/SLA.0B013E3181B13CA2
doi: 10.1097/SLA.0B013E3181B13CA2
pubmed: 19638912
Westermann C, Weller J, Patel P, Rhee DS, Garcia AV (2022) Evaluation of the surgical management of achalasia in children and young adults. J Surg Res 273:9–14. https://doi.org/10.1016/J.JSS.2021.12.004
doi: 10.1016/J.JSS.2021.12.004
pubmed: 35007858
Gould JL, Rentea RM, Peter SD (2016) Contemporary management of Achalasia by pediatric surgeons: a survey of the international pediatric endosurgical group. J Laparoendosc Adv Surg Tech 26:567–569. https://doi.org/10.1089/lap.2016.0085
doi: 10.1089/lap.2016.0085
Adikibi BT, MacKinlay GA, Munro FD, Khan LR, Gillett PM (2009) Intraoperative upper GI endoscopy ensures an adequate laparoscopic Heller’s myotomy. J Laparoendosc Adv Surg Tech A 19:687–689. https://doi.org/10.1089/LAP.2008.0156
doi: 10.1089/LAP.2008.0156
pubmed: 19694563
Stefanidis D, Richardson W, Farrell TM, Kohn GP, Augenstein V, Fanelli RD (2012) SAGES guidelines for the surgical treatment of esophageal achalasia. Surg Endosc 26:296–311. https://doi.org/10.1007/S00464-011-2017-2
doi: 10.1007/S00464-011-2017-2
pubmed: 22044977
Ballouhey Q, Dib N, Binet A, Carcauzon-Couvrat V, Clermidi P, Longis B, Lardy H, Languepin J, Cros J, Fourcade L (2017) How robotic-assisted surgery can decrease the risk of mucosal tear during Heller myotomy procedure? J Robot Surg 11:255–258. https://doi.org/10.1007/S11701-016-0658-9
doi: 10.1007/S11701-016-0658-9
pubmed: 27822660
Delgado-Miguel C, Amarnath RP, Camps JI (2023) Robotic-assisted vs laparoscopic Heller’s myotomy for achalasia in children. J Pediatr Surg. https://doi.org/10.1016/J.JPEDSURG.2023.11.003
doi: 10.1016/J.JPEDSURG.2023.11.003
pubmed: 38016851
Mussies C, van Lennep M, van der Lee JH, Singendonk MJ, Benninga MA, Bastiaansen BA, Fockens P, Bredenoord AJ, van Wijk MP (2023) Protocol for an international multicenter randomized controlled trial assessing treatment success and safety of peroral endoscopic myotomy vs endoscopic balloon dilation for the treatment of achalasia in children. PLoS ONE. https://doi.org/10.1371/JOURNAL.PONE.0286880
doi: 10.1371/JOURNAL.PONE.0286880
pubmed: 37796851
pmcid: 10553306