Peroral endoscopic myotomy for hypercontractile (Jackhammer) esophagus: a retrospective multicenter series with long-term follow-up

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023001%3A_____%2F24%3A00085048" target="_blank" >RIV/00023001:_____/24:00085048 - isvavai.cz</a>

Result on the web

<a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/ueg2.12586" target="_blank" >https://onlinelibrary.wiley.com/doi/epdf/10.1002/ueg2.12586</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1002/ueg2.12586" target="_blank" >10.1002/ueg2.12586</a>

Result language

angličtina

Original language name

Peroral endoscopic myotomy for hypercontractile (Jackhammer) esophagus: a retrospective multicenter series with long-term follow-up

Original language description

Introduction: Long-term outcome data are limited for non-achalasia esophageal motility disorders treated by peroral endoscopy myotomy (POEM) as a separate group. We investigated a subset of symptomatic patients with hypercontractile esophagus (Jackhammer esophagus). Methods: Forty two patients (mean age 60.9 years; 57% female, mean Eckardt score 6.2 +/- 2.1) treated by primary peroral myotomy for symptomatic Jackhammer esophagus 2012-2018 in seven European centers were retrospectively analyzed; myotomy included the lower esophageal sphincter but did not extend more than 1 cm into the cardia in contrast to POEM for achalasia. Manometry data were re-reviewed by an independent expert. The main outcome was the failure rate defined by retreatment or an Eckardt score &gt;3 after at least two years following POEM. Results: Despite 100% technical success (mean intervention time 107 +/- 48.9 min, mean myotomy length 16.2 +/- 3.7 cm), the 2-year success rate was 64.3% in the entire group. In a subgroup analysis, POEM failure rates were significantly different between Jackhammer-patients without (n = 22), and with esophagogastric junction outflow obstruction (EGJOO, n = 20) (13.6% % vs. 60%, p = 0.003) at a follow-up of 46.5 +/- 19.0 months. Adverse events occurred in nine cases (21.4%). 14 (33.3%) patients were retreated, two with surgical fundoplication due to reflux. Including retreatments, an improvement in symptom severity was found in 33 (78.6%) at the end of follow-up (Eckardt score &lt;= 3, mean Eckardt change 4.34, p &lt; 0.001). EGJOO (p = 0.01) and frequency of hypercontractile swallows (p = 0.02) were predictors of POEM failure. The development of a pseudodiverticulum was observed in four cases within the subgroup of EGJOO. Conclusions: Patients with symptomatic Jackhammer without EGJOO benefit from POEM in long-term follow-up. Treatment of Jackhammer with EGJOO, however, remains challenging and probably requires full sphincter myotomy and future studies which should address the pathogenesis of this variant and alternative strategies.

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30219 - Gastroenterology and hepatology

Project

—

Continuities

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Publication year

2024

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

United European gastroenterology journal

ISSN

2050-6406

e-ISSN

2050-6414

Volume of the periodical

12

Issue of the periodical within the volume

7

Country of publishing house

GB - UNITED KINGDOM

Number of pages

11

Pages from-to

930-940

UT code for WoS article

001247362300001

EID of the result in the Scopus database

2-s2.0-85196141792