Geriatric patients with esophageal motility disorders benefit more from minimally invasive peroral endoscopic myotomy: a multicenter study in Japan

2021 ◽  
Author(s):  
Naoto Ujiie ◽  
Hiroki Sato ◽  
Mary Raina Angeli Fujiyoshi ◽  
Shinwa Tanaka ◽  
Hironari Shiwaku ◽  
...  
Keyword(s):  
Chest Pain ◽  
Minimally Invasive ◽  
Reflux Esophagitis ◽  
Lower Incidence ◽  
Esophageal Motility ◽  
Geriatric Patients ◽  
Peroral Endoscopic Myotomy ◽  
Esophageal Motility Disorders ◽  
Motility Disorders ◽  
Endoscopic Myotomy

Summary Geriatric patients with existing studies on the safety and efficacy of peroral endoscopic myotomy (POEM) for achalasia involve small sample sizes and single institutions. However, multi-center, large-scale data analyses are lacking. The study aimed to clarify the characteristics of geriatric patients with esophageal motility disorders (EMDs) and determine the procedure-related outcomes and clinical course following POEM. This cohort study included 2,735 patients with EMDs who were treated at seven Japanese facilities between 2010 and 2019. The patients’ characteristics and post-POEM clinical courses were compared between the geriatric (age ≥ 75 years; n = 321) and non-geriatric (age < 75 years; n = 2,414) groups. Compared with the non-geriatric group, the geriatric group had higher American Society of Anesthesiologists physical status scores; more recurrent cases; lower incidence of chest pain; and higher incidence of type III achalasia, distal esophageal spasm, and Jackhammer esophagus. Furthermore, the incidence of sigmoid esophagus was higher, although esophageal dilation was not severe in this group. POEM was safe and effective for geriatric patients with treatment-naïve and recurrent EMDs. Furthermore, compared with the non-geriatric group, the geriatric group had lower post-POEM Eckardt scores, fewer complaints of refractory chest pain, and a lower incidence rate of post-POEM reflux esophagitis. Geriatric patients are characterized by worse clinical conditions, more spastic disorders, and greater disease progression of EMDs, which are also the indications for minimally invasive POEM. POEM is more beneficial in geriatric patients as it has lowering symptom scores and incidence rates of reflux esophagitis.

Peroral endoscopic myotomy (POEM) is effective in treatment of noncardiac chest pain caused by hypercontractile esophageal motility disorders: results of the POEM-HYPE-Study

2018 ◽  
Vol 56 (11) ◽  
pp. 1337-1342 ◽  
Author(s):  
David Albers ◽  
Thomas Frieling ◽  
Dani Dakkak ◽  
Rita Kuhlbusch-Zicklam ◽  
Ulrich Töx ◽  
...  
Keyword(s):  
Chest Pain ◽  
High Resolution ◽  
Gastroesophageal Reflux ◽  
Esophageal Motility ◽  
Symptom Relief ◽  
Peroral Endoscopic Myotomy ◽  
Esophageal Motility Disorders ◽  
Noncardiac Chest Pain ◽  
Motility Disorders ◽  
Endoscopic Myotomy

Abstract Background Noncardiac chest pain (NCCP) is recurrent angina pectoris-like pain without evidence of coronary heart disease in conventional diagnostic evaluation. In gastroenterology, managing of patients with NCCP is ambiguous to detect gastroesophageal reflux and hypercontractile esophageal motility disorders. Recently, peroral endoscopic myotomy (POEM) was established as treatment option in achalasia. However, limited data exist on the effectivity of POEM in NCCP with hypercontractile esophageal motility disorders. Material and methods In this prospective study (POEM-HYPE), we evaluated 14 patients with NCCP and hypercontractile esophageal motility disorders (type III achalasia, n = 7; hypercontractile esophagus, n = 6; distal esophageal spasm, n = 1). All patients underwent standardized diagnostic work-up including esophagogastroduodenoscopy with esophageal biopsies, high-resolution esophageal manometry, and combined intraluminal impedance and pH testing before and 3 weeks after POEM. A standardized symptom questionnaire was disposed before POEM, 3 weeks after, and every 6 months after the POEM. Results After POEM, 12 patients showed significant symptom relief (pre-Eckardt score: 7.78 ± 1.47, 3 weeks post: 1.64 ± 1.44, 6 months: 2.0 ± 1.84 and 1.86 ± 1.89 after 15.0 ± 10.0 months post-intervention). High-resolution manometry showed significant reduction in integrated relaxation pressure (pre-POEM: 24.74 ± 18.9 mm Hg, post-POEM: 13.8 ± 16.5 mm Hg) and distal contractile integral (pre-POEM: 2880 ± 3700 mmHg*s*cm, post-POEM: 1109 ± 1042 mmHg*s*cm). One lesion of the submucosal tunnel occurred as a moderate adverse event and was handled endoscopically. The long-term clinical success rate was 85.7 %. No severe gastroesophageal reflux occurred after interventions. Two patients required secondary therapy with injection of botulinum toxin in the tubular esophagus and balloon dilation. Conclusion The results suggest that POEM is an effective and safe therapeutic option for patients with NCCP and hypercontractile esophageal motility disorders.

scholarly journals Experience with Peroral Endoscopic Myotomy for Achalasia and Spastic Esophageal Motility Disorders at a Tertiary U.S. Center

2020 ◽  
Vol 53 (3) ◽  
pp. 321-327 ◽  
Author(s):  
Maen Masadeh ◽  
Peter Nau ◽  
Subhash Chandra ◽  
Jagpal Klair ◽  
John Keech ◽  
...  
Keyword(s):  
Esophageal Motility ◽  
Peroral Endoscopic Myotomy ◽  
Esophageal Motility Disorders ◽  
Motility Disorders ◽  
Endoscopic Myotomy

scholarly journals Clinical impact of peroral endoscopic myotomy for esophageal motility disorders on esophageal muscle layer thickness

2019 ◽  
Vol 07 (04) ◽  
pp. E525-E532
Author(s):  
Daisuke Watanabe ◽  
Shinwa Tanaka ◽  
Fumiaki Kawara ◽  
Hirohumi Abe ◽  
Ryusuke Ariyoshi ◽  
...  
Keyword(s):  
Layer Thickness ◽  
Esophageal Motility ◽  
Circular Muscle ◽  
Muscle Layer ◽  
Peroral Endoscopic Myotomy ◽  
Esophageal Motility Disorders ◽  
Pathological Features ◽  
Motility Disorders ◽  
Endoscopic Myotomy ◽  
Esophageal Muscle

Abstract Background and study aims Previously, we reported that esophageal muscle layer thickness was associated with technical complexity of peroral endoscopic myotomy (POEM). However, there are no data regarding the mid-term effects of POEM procedures on esophageal muscle layer thickness. Therefore, we conducted this study to elucidate mid-term effects of POEM procedures, and to examine whether postoperative changes in esophageal muscle layer thickness were related to particular clinico-pathological features in patients with esophageal motility disorders. Patients and methods Seventy-four consecutive patients with esophageal motility disorders who underwent POEM at Kobe University Hospital from April 2015 to December 2016 were prospectively recruited into this study. First, we investigated the esophageal muscle layer thickness values obtained at 1 year after POEM. Second, we evaluated the effects of a reduction in muscle layer thickness on various clinico-pathological features. Results At 1 year after POEM, mean thickness of the inner circular muscle at 0 cm, 5 cm, and 10 cm from the esophagogastric junction was 1.06 ± 0.45 mm, 0.99 ± 0.36 mm, and 0.97 ± 0.44 mm, respectively. Among all sites, muscle layer thickness had significantly decreased after POEM. However, univariate logistic regression analysis demonstrated that no clinical factors were associated with esophageal muscle layer thickness after POEM procedure. Conclusions We demonstrated for the first time that thickness of the esophageal muscle layer was significantly decreased after POEM. This result reveals that changes in esophageal muscle layer thickness caused by esophageal motility disorders are reversible.

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