Peroral endoscopic myotomy is a safe and effective treatment modality for geriatric patients with achalasia
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ORIGINAL ARTICLE
Peroral endoscopic myotomy is a safe and effective treatment modality for geriatric patients with achalasia Madhusudhan R. Sanaka1 · Pravallika Chadalavada2 · Mohammad Alomari2 · Andrew Tang3 · Malav Parikh1 · Rajat Garg1 · Niyathi Gupta1 · Prashanthi Thota1 · Scott Gabbard1 · Sudish Murthy3 · Siva Raja3 Received: 16 January 2020 / Accepted: 26 April 2020 © The Japan Esophageal Society 2020
Abstract Background Peroral endoscopic myotomy (POEM) is an appealing treatment for older patients, as it is minimally invasive but highly efficacious similar to surgical myotomy. However, there is a lack of systematic studies analyzing POEM outcomes in young ( 14.72 or total abnormal acid exposure time > 5.5% (i.e., esophageal pH 6.8%), upright position (abnormal if > 8.2%), and supine position (abnormal if > 3%). These are based on the reference values we use in our institution.
GERD symptoms and Eckardt scores The presence or absence of GERD symptoms and Eckardt symptom scores were recorded at the time of clinical followup visit, typically 2 months after POEM.
Statistical analysis Features of distributions of continuous variables were presented as median (25th, 75th percentiles) and categorical variables as counts and frequency. Univariable analysis was performed to assess differences between the treatment groups. Wilcoxon signed rank test was used to compare continuous variables. Fisher’s exact test was used for comparing proportions of contingency tables including expected frequency less than five. All statistical analyses were performed using R foundation for statistical computing (R version 3.5.3; Vienna, Austria), and a p value 14.72) were also not significantly different between the two groups (49.3% vs. 60.5%, p = 0.358).
Subgroup analysis in patients who had prior LHM We performed a subgroup analysis of the patients who underwent prior LHM in our study. A total of 26 young patients and 4 old patients underwent prior LHM. Treatment success was similar in both young and old patients (92.3% vs. 100%, p > 0.99). There was similar improvement in LESIRP between the young and old patients (9.95 mmHg vs. 6.7 mmHg, p = 0.61). Improvement in TBE height at 1 min was higher in the old patients (1.3 cm vs. 13.7 cm, p = 0.03). However, the improvement in all the other TBE parameters were comparable between the young and old patients (Table 4).
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Esophagus Table 1 Demographics and baseline characteristics Variables
6) Prior treatments None Botox Pneumatic dilation Heller myotomy Botox and dilation CRE or savory dilation
93 93 93
93 93 84
> 65 years
N (%) or median (Q1-3)
N (%) or median (Q1-3)
93
55 52 (43, 58) 51 (54.8)
71 (76.3) 12 (12.9) 1 (1.1) 9 (11.4)) 30.14 (25.17, 35.51) 3.00 (2.00, 3.00)
55 55 55
54 55
29 (32.6) 45 (50.6) 10 (11.2) 5 (5.6)
74 (70, 79) 31 (56.4) 42 (76.4) 3 (5.5) 0 (0.0) 10 (18.2) 27.30 (23.88, 30.27) 3.00 (3.00, 4.00) 13 (25.0) 24 (46.2) 11 (21.2) 4 (7.7)
p
14.72) DeMeester score GERD symptoms
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