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How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective.

ABSTRACT: Background and study aims ?Both Heller myotomy (HM) and per-oral endoscopic myotomy (POEM) are efficacious therapies for achalasia. The efficacy and safety of POEM vs HM in Latin America and specifically in patients with Chagas disease is unknown. Patients and methods ?Consecutive patients undergoing either HM or POEM for achalasia were included from nine Latin American centers in a prospective registry over 5 years. Technical success was defined as undergoing a successful myotomy. Clinical success was defined as achieving an Eckardt score

SUBMITTER: Kahaleh M

PROVIDER: S-EPMC7508649 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective.

Kahaleh Michel M Tyberg Amy A Suresh Supriya S Lambroza Arnon A Gaidhane Monica M Zamarripa Felipe F Martínez Guadalupe Ma GM Carames Juan C JC Moura Eduardo T ET Farias Galileu F GF Porfilio Maria G MG Nieto Jose J Rey Mario M Rodriguez Casas Fernando F Mondragón Hernández Oscar V OV Vargas-Rubio Romulo R Canadas Raul R Hani Albis A Munoz Guillermo G Castillo Bismarck B Lukashok Hannah P HP Robles-Medranda Carlos C de Moura Eduardo G EG

Endoscopy international open 20200922 10

<b>Background and study aims</b> Both Heller myotomy (HM) and per-oral endoscopic myotomy (POEM) are efficacious therapies for achalasia. The efficacy and safety of POEM vs HM in Latin America and specifically in patients with Chagas disease is unknown. <b>Patients and methods</b> Consecutive patients undergoing either HM or POEM for achalasia were included from nine Latin American centers in a prospective registry over 5 years. Technical success was defined as undergoing a successful myotomy. ...[more]

PMID: 33015342

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Project description:IntroductionPeroral endoscopic myotomy (POEM) is the standard treatment for achalasia. Functional luminal imaging probe (FLIP) technology enables objective measurement of lower esophageal sphincter (LES) geometry, with literature linking specific values to improved post-POEM outcomes. Our study assesses FLIP's intraoperative use in evaluating myotomy extent in real-time.MethodsRetrospective data from all patients undergoing POEM with intraoperative FLIP measurements were extracted from June 2020 to January 2023. The primary endpoint was intraoperative FLIP measurements, management changes, and symptom improvement (Eckardt score).ResultsFourteen patients (age 56 ± 14 years, BMI 28 ± 7 kg/m2) were identified. Most patients were female (64%). Predominantly, patients presented with type II achalasia (50%). FLIP measurements were taken before and after myotomy, demonstrating increases in mean distensibility index (DI) 1.6 ± 1. 4 to 5.4 ± 2.1 mm2/mmHg (p < 0.05) and mean diameter (Dmin) 6 ± 1.8 to 10.9 ± 2.3 mm (p < 0.05) at 50 ml balloon fill. Additional myotomy was performed in one patient when an inadequate increase in FLIP values were noted. Mean operative time was 98 ± 28 min, and there were no intraoperative complications. At the 30-day follow-up, median Eckardt score decreased from mean a preoperative score of 7 ± 2 to a post-operative mean of 2 ± 3, with 10 patients (78%) having a score ≤ 2. In total, four patients experienced symptom recurrence, with repeat FLIP values revealing a significant decrease in DI from 7 ± 2.2 post-POEM to 2.5 ± 1.5 at recurrence. FLIP technology identified LES pathology in 3 out of 4 (75%) patients, facilitating referral to LES-directed therapy.ConclusionOur study adds to the literature supporting the use of FLIP technology during the POEM procedure, with most patients achieving ideal values after a standard-length myotomy. This suggests the potential benefits of shorter myotomies guided by FLIP to achieve comparable outcomes and reduce postoperative GERD risk. Collaborative standardization of study designs and outcome measures is crucial for facilitating prospective trials and cross-setting outcome comparisons.

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How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective.

Publications

How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective.

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