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Efficacy of per-oral endoscopic myotomy for the treatment of non-achalasia esophageal motor disorders

  • Lucie Bernardot
  • Sabine Roman
  • Maximilien Barret
  • Véronique Vitton
  • Timothée Wallenhorst
  • Mathieu Pioche
  • Stanislas Chaussade
  • Jean-Michel Gonzalez
  • Thierry Ponchon
  • Frédéric Prat
  • Marc Barthet
  • Julien Vergniol
  • Edouard Chabrun
  • Frank ZerbibEmail author
Article
  • 6 Downloads

Abstract

Introduction

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.

Results

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).

Conclusion

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.

Keywords

POEM Esophageal spasms Hypercontractile esophagus High-resolution manometry 

Notes

Compliance with ethical standards

Disclosures

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.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  • Lucie Bernardot
    • 1
  • Sabine Roman
    • 2
  • Maximilien Barret
    • 3
  • Véronique Vitton
    • 4
  • Timothée Wallenhorst
    • 5
  • Mathieu Pioche
    • 2
  • Stanislas Chaussade
    • 3
  • Jean-Michel Gonzalez
    • 4
  • Thierry Ponchon
    • 2
  • Frédéric Prat
    • 3
  • Marc Barthet
    • 4
  • Julien Vergniol
    • 1
  • Edouard Chabrun
    • 1
  • Frank Zerbib
    • 1
    • 6
    Email author
  1. 1.CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology DepartmentUniversité de Bordeaux; INSERM CIC 1401BordeauxFrance
  2. 2.Hospices Civils de Lyon, Hôpital E Herriot, GastroenterologyUniversité de Lyon; Inserm U1032, LabTAULyonFrance
  3. 3.Gastroenterology DepartmentAP-HP, Hôpital CochinParisFrance
  4. 4.Gastroenterology DepartmentAP-HM, Hôpital NordMarseilleFrance
  5. 5.Gastroenterology DepartmentCHU de RennesRennesFrance
  6. 6.Gastroenterology and Hepatology DepartmentCentre Medico-Chirurgical Magellan Haut-Lévêque Hospital, CHU de BordeauxPessacFrance

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