2013年10月
Peroral Endoscopic Myotomy Is a Viable Option for Failed Surgical Esophagocardiomyotomy Instead of Redo Surgical Heller Myotomy: A Single Center Prospective Study
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
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- 巻
- 217
- 号
- 4
- 開始ページ
- 598
- 終了ページ
- 605
- 記述言語
- 英語
- 掲載種別
- 研究論文(学術雑誌)
- DOI
- 10.1016/j.jamcollsurg.2013.05.025
- 出版者・発行元
- ELSEVIER SCIENCE INC
BACKGROUND: Surgical Heller myotomy has high rates of successful long-term results, but failed cases still remain. Moreover, the treatment strategy in patients with surgical myotomy failure is controversial. Recently, peroral endscopic myotomy (POEM) was reported to be efficient and safe in primary treatment of achalasia. In this study, we aimed to evaluate the efficacy and safety of POEM for surgical myotomy failure as a rescue second-line treatment, and we discuss the treatment options adapted in achalasia recurrence.
STUDY DESIGN: A total of 315 consecutive achalasia patients received POEM from September 2008 to December 2012 in our hospital. Eleven (3.5%) patients who had persistent or recurrent achalasia and had received surgical myotomy as a first-line treatment from other hospitals were included in this study. Patient background, barium swallow studies, esophagogastroduodenoscopy (EGD), manometry, and symptom scores were prospectively evaluated. In principle, all patients in whom surgical myotomy failed received pneumatic balloon dilatation (PBD) as the first line " rescue" treatment, and only if PBD failed were patients considered for rescue POEM.
RESULTS: The PBD alone was effective in 1 patient, and in the remaining 10 patients, rescue POEM was performed successfully without complications. Three months after rescue POEM, significant reduction in lower esophageal sphincter (LES) resting pressures (22.1 +/- 6.6 mmHg vs 10.9 +/- 4.5 mmHg, p < 0.01) and Eckardt symptom scores (6.5 +/- 1.3 vs 1.1 +/- 1.3, p < 0.001) were observed.
CONCLUSIONS: Short-term results of POEM for failed surgical myotomy were excellent. Long-term results are awaited. (C) 2013 by the American College of Surgeons
STUDY DESIGN: A total of 315 consecutive achalasia patients received POEM from September 2008 to December 2012 in our hospital. Eleven (3.5%) patients who had persistent or recurrent achalasia and had received surgical myotomy as a first-line treatment from other hospitals were included in this study. Patient background, barium swallow studies, esophagogastroduodenoscopy (EGD), manometry, and symptom scores were prospectively evaluated. In principle, all patients in whom surgical myotomy failed received pneumatic balloon dilatation (PBD) as the first line " rescue" treatment, and only if PBD failed were patients considered for rescue POEM.
RESULTS: The PBD alone was effective in 1 patient, and in the remaining 10 patients, rescue POEM was performed successfully without complications. Three months after rescue POEM, significant reduction in lower esophageal sphincter (LES) resting pressures (22.1 +/- 6.6 mmHg vs 10.9 +/- 4.5 mmHg, p < 0.01) and Eckardt symptom scores (6.5 +/- 1.3 vs 1.1 +/- 1.3, p < 0.001) were observed.
CONCLUSIONS: Short-term results of POEM for failed surgical myotomy were excellent. Long-term results are awaited. (C) 2013 by the American College of Surgeons
- リンク情報
- ID情報
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- DOI : 10.1016/j.jamcollsurg.2013.05.025
- ISSN : 1072-7515
- PubMed ID : 23891071
- Web of Science ID : WOS:000325152100006