Efficacy of per-oral endoscopic myotomy for the treatment of non-achalasia esophageal motor disorders
- 6 Downloads
Per-oral endoscopic myotomy (POEM) is effective in achalasia. The objective of this study was to evaluate the short-term clinical efficacy of POEM in non-achalasia esophageal motility disorders (NAEMD).
Patients and methods
Patients with NAEMD diagnosed by high-resolution manometry were included in a retrospective multicentric study. For each individual case, two controls paired on gender and age were matched: one with type I/II achalasia and one with type III achalasia. The clinical response, defined by an Eckardt score ≤ 3, was assessed at 3 and 6 months.
Ninety patients (mean age 66 years, 57 men) were included, 30 patients with NAEMD (13 jackhammer esophagus, 6 spastic esophageal disorders, 4 nutcracker esophagus, and 7 esophagogastric junction obstruction), 30 patients with type I–II achalasia, and 30 patients with type III achalasia. The 3-month response rates were 80% (24/30), 90% (27/30), and 100% (30/30) in NAEMD, type I–II achalasia and type III achalasia, respectively (p < 0.01). Eckardt scores improved from preoperative baseline in all groups (median scores 2.0 after POEM vs. 6.5 before POEM, 1.3 vs. 7.2, and 0.5 vs. 6.1 in NAEMD, type I//I and Type III, respectively). No predictive factor of response was identified. In NAEMD patients, there was a significant improvement of dysphagia, regurgitation, and chest pain scores. The 6-month response rates were 63.2% (12/19), 95.5% (21/22), and 87.0% (20/23) in NAEMD, type I–II achalasia and type III achalasia, respectively (p = 0.03).
Although less effective than in achalasia, POEM is an effective treatment for NAEMD. Long-term follow-up data are needed to further confirm that POEM may be a valid treatment of NAEMD.
KeywordsPOEM Esophageal spasms Hypercontractile esophagus High-resolution manometry
Compliance with ethical standards
S. Roman: Medtronic, Diversatek, Mayoli Spindler, Biocodex, M. Barret: Olympus, Cook, V. Vitton: Ipsen, Biocodex, Sanofi, Kyowa Kirin, Medtronic, T. Wallenhorst: Cook Medical, Fujifilm, Abbvie, Ipsen, M. Pioche: Boston Scientific, Olympus, Norgine, S. Chaussade: Fujifilm, Olympus, J.-M. Gonzalez: Cook, Cousin, T. Ponchon: Olympus, F. Prat: Boston Scientific, Olympus, Pentax, M. Barthet: Boston Scientific, J. Vergniol: none, E. Chabrun: Olympus, Boston Scientific, Cook Medical, Life Partners Europe, F. Zerbib: Takeda, Allergan, Biocodex, Vifor Pharma, Mayoli Spindler, Ipsen, Abbott, Reckitt Benckiser, Alfasigma. L. Bernardot: no conflict of interest or financial ties to disclose.
- 3.Haito-Chavez Y, Inoue H, Beard KW, Draganov PV, Ujiki M, Rahden BHA, Desai PN, Pioche M, Hayee B, Haji A, Saxena P, Reavis K, Onimaru M, Balassone V, Nakamura J, Hata Y, Yang D, Pannu D, Abbas A, Perbtani YB, Patel LY, Filser J, Roman S, Rivory J, Mion F, Ponchon T, Perretta S, Wong V, Maselli R, Ngamruengphong S, Chen YI, Bukhari M, Hajiyeva G, Ismail A, Pieratti R, Kumbhari V, Galdos-Cardenas G, Repici A, Khashab MA (2017) Comprehensive analysis of adverse events associated with per oral endoscopic myotomy in 1826 patients: an international multicenter study. Am J Gastroenterol 112:1267–1276CrossRefGoogle Scholar
- 7.Vanuytsel T, Bisschops R, Farre R, Pauwels A, Holvoet L, Arts J, Caenepeel P, De Wulf D, Mimidis K, Rommel N, Tack J (2013) Botulinum toxin reduces dysphagia in patients with nonachalasia primary esophageal motility disorders. Clin Gastroenterol Hepatol 11(1115–1121):e1112Google Scholar
- 10.Khashab MA, Familiari P, Draganov PV, Aridi HD, Cho JY, Ujiki M, Rio Tinto R, Louis H, Desai PN, Velanovich V, Albeniz E, Haji A, Marks J, Costamagna G, Deviere J, Perbtani Y, Hedberg M, Estremera F, Martin Del Campo LA, Yang D, Bukhari M, Brewer O, Sanaei O, Fayad L, Agarwal A, Kumbhari V, Chen YI (2018) Peroral endoscopic myotomy is effective and safe in non-achalasia esophageal motility disorders: an international multicenter study. Endosc Int Open 6:E1031–e1036CrossRefGoogle Scholar
- 13.Kumbhari V, Tieu A, Onimaru M, El Zein M, Teitelbaum E, Gitelis M, Modayil R, Hungness ES, Stravopoulos S, Shiwaku H, Kunda R, Chiu P, Saxena P, Messallam A, Inoue H, Khashab M (2015) Peroral endoscopy myotomy vs laparoscopic Heller myotomy for the treatment of type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open 3:E195–E201CrossRefGoogle Scholar