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

Kód výsledku v 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>

Výsledek na webu

<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>

Jazyk výsledku

angličtina

Název v původním jazyce

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

Popis výsledku v původním jazyce

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.

Název v anglickém jazyce

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

Popis výsledku anglicky

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.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30219 - Gastroenterology and hepatology

Projekt

—

Návaznosti

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Rok uplatnění

2024

Kód důvěrnosti údajů

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

Název periodika

United European gastroenterology journal

ISSN

2050-6406

e-ISSN

2050-6414

Svazek periodika

12

Číslo periodika v rámci svazku

7

Stát vydavatele periodika

GB - Spojené království Velké Británie a Severního Irska

Počet stran výsledku

11

Strana od-do

930-940

Kód UT WoS článku

001247362300001

EID výsledku v databázi Scopus

2-s2.0-85196141792