Outcomes of Per-oral Endoscopic Myotomy in Sigmoid and Advanced Sigmoid Achalasia
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RESEARCH COMMUNICATION
Outcomes of Per-oral Endoscopic Myotomy in Sigmoid and Advanced Sigmoid Achalasia Zaheer Nabi 1 & Mohan Ramchandani 1 & Jahangeer Basha 1 & Rajesh Goud 1 & Santosh Darisetty 1 & D. Nageshwar Reddy 1 Received: 20 May 2020 / Accepted: 6 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Esophageal Achalasia; Peroral Endoscopic Myotomy; Follow-up Study
Sigmoid achalasia may develop in up to 10% of patients with longstanding achalasia.1 Heller’s myotomy (HM) is considered the preferred modality of treatment in these patients. Few small studies with short follow-up duration suggest that peroral endoscopic myotomy (POEM) may be an effective alternative to HM in these cases.2–5 In this study, we evaluated the outcomes of POEM in sigmoid and advanced sigmoid-type achalasia.
(Eckardt ≤ 3) was evaluated at long-term follow-up (> 3 years). Objective evaluation including esophageal manometry, upper GI endoscopy, and 24-h pH study were performed at 3 months. A timed barium esophagogram was performed at 3 months and yearly, thereafter. The demographics and POEM procedural characteristics are presented as mean ± SD or median (range). Categorical and continuous variables were compared using the chi-square test and Student’s t test, respectively. A p value < 0.05 was considered statistically significant.
Methods
Results
The data of patients who underwent POEM (December 2014 to November 2018) for sigmoid achalasia was analyzed, retrospectively. The sigmoid esophagus was categorized into sigmoid and advanced sigmoid achalasia.6 Clinical success
Thirty-two patients (23 males, mean age 43.84 ± 13.29 years) underwent POEM for sigmoid (n = 22) and advanced sigmoid achalasia (n = 10). Sixteen (50%) patients received previous treatment (pneumatic dilatation-13, HM-3). POEM was successfully performed in all the patients with a mean procedure duration of 62.69 ± 32.71 min. Severe submucosal fibrosis requiring double tunnel POEM was found in five patients. The mean follow-up was 34.03 ± 13.78 months. Of these, long-term follow-up (≥ 3 years) was completed in 11 patients. Overall, clinical success was recorded in 27 (84%) patients. Long-term clinical success was seen in 8 (72.7%) patients. Eckardt scores were higher at long-term follow-up (1.18 ± 0.87 vs 2.54 ± 1.75; p = 0.032). The mean duration of symptoms was significantly more in patients with relapse of symptoms (166.40 ± 44.77 vs 101.04 ± 32.81 months; p = 0.001) (Table 1). Deterioration in the free flow of barium at ≥ 1-year follow-up (n = 21) was evident in 10 (47.6%) patients on follow-up (Fig. 1). Major adverse events occurred in two patients including delayed mucosal barrier failure (1) and symptomatic pleural effusion requiring drainage (1). Increased esophageal acid exposure was detected in 3 patients. Erosive esophagitis was
Introduction
* Zaheer Nabi [email protected] Mohan Ramchandani [email protected] Jahangeer Basha [email protected] Rajesh Goud [email protected] Santosh Darisetty sant_dar
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