Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study
Background and study aims: Type III achalasia is characterized by rapidly propagating pressurization attributable to spastic contractions. Although laparoscopic Heller myotomy (LHM) is the current gold standard management for type III achalasia, peroral endoscopic myotomy (POEM) is conceivably super...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2015-04-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1391668 |
| _version_ | 1818501691753889792 |
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| author | Vivek Kumbhari Alan H Tieu Manabu Onimaru Mohammad H. El Zein Ezra N. Teitelbaum Michael B. Ujiki Matthew E. Gitelis Rani J. Modayil Eric S. Hungness Stavros N. Stavropoulos Hiro Shiwaku Rastislav Kunda Philip Chiu Payal Saxena Ahmed A. Messallam Haruhiro Inoue Mouen A. Khashab |
| author_facet | Vivek Kumbhari Alan H Tieu Manabu Onimaru Mohammad H. El Zein Ezra N. Teitelbaum Michael B. Ujiki Matthew E. Gitelis Rani J. Modayil Eric S. Hungness Stavros N. Stavropoulos Hiro Shiwaku Rastislav Kunda Philip Chiu Payal Saxena Ahmed A. Messallam Haruhiro Inoue Mouen A. Khashab |
| author_sort | Vivek Kumbhari |
| collection | DOAJ |
| description | Background and study aims: Type III achalasia is characterized by rapidly propagating pressurization attributable to spastic contractions. Although laparoscopic Heller myotomy (LHM) is the current gold standard management for type III achalasia, peroral endoscopic myotomy (POEM) is conceivably superior because it allows for a longer myotomy. Our aims were to compare the efficacy and safety of POEM with LHM for type III achalasia patients.
Patients and methods: A retrospective study of 49 patients who underwent POEM for type III achalasia across eight centers were compared to 26 patients who underwent LHM at a single institution. Procedural data were abstracted and pre- and post-procedural symptoms were recorded. Clinical response was defined by improvement of symptoms and decrease in Eckardt stage to ≤ 1. Secondary outcomes included length of myotomy, procedure duration, length of hospital stay, and rate of adverse events.
Results: Clinical response was significantly more frequent in the POEM cohort (98.0 % vs 80.8 %; P = 0.01). POEM patients had significantly shorter mean procedure time than LHM patients (102 min vs 264 min; P < 0.01) despite longer length of myotomy (16 cm vs 8 cm; P < 0.01). There was no significant difference between POEM and LHM in the length of hospital stay (3.3 days vs 3.2 days; P = 0.68), respectively. Rate of adverse events was significantly less in the POEM group (6 % vs 27 %; P < 0.01).
Conclusions: POEM allows for a longer myotomy than LHM, which may result in improved clinical outcomes. POEM appears to be an effective and safe alternative to LHM in patients with type III achalasia. |
| first_indexed | 2024-12-10T20:59:45Z |
| format | Article |
| id | doaj.art-5be9932361974dfb97cfcffce3c74f5f |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-12-10T20:59:45Z |
| publishDate | 2015-04-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-5be9932361974dfb97cfcffce3c74f5f2022-12-22T01:33:51ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362015-04-010303E195E20110.1055/s-0034-1391668Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative studyVivek Kumbhari0Alan H Tieu1Manabu Onimaru2Mohammad H. El Zein3Ezra N. Teitelbaum4Michael B. Ujiki5Matthew E. Gitelis6Rani J. Modayil7Eric S. Hungness8Stavros N. Stavropoulos9Hiro Shiwaku10Rastislav Kunda11Philip Chiu12Payal Saxena13Ahmed A. Messallam14Haruhiro Inoue15Mouen A. Khashab16Johns Hopkins Medical Institutions, Gastroenterology and Hepatology, Baltimore, Maryland, United StatesJohns Hopkins Medical Institutions, Gastroenterology and Hepatology, Baltimore, Maryland, United StatesShowa University Northern Yokohama Hospital, Digestive Disease Center, Yokohama, JapanJohns Hopkins Medical Institutions, Gastroenterology and Hepatology, Baltimore, Maryland, United StatesNorthwestern University Feinberg School of Medicine, Department of Surgery, Chicago, Illinois, United StatesNorthShore University Health Systems, NorthShore Center for Simulation and Innovation, Evanston, Illinois, United StatesNorthShore University Health Systems, NorthShore Center for Simulation and Innovation, Evanston, Illinois, United StatesWinthrop University Hospital, Gastroenterology and Hepatology, Mineola, New York, United StatesNorthwestern University Feinberg School of Medicine, Department of Surgery, Chicago, Illinois, United StatesWinthrop University Hospital, Gastroenterology and Hepatology, Mineola, New York, United StatesFukuoka University Faculty of Medicine, Gastroenterology and Hepatology, Fukuoka, JapanAarhus University Hospital, Department of Surgery, Aarhus, DenmarkInstitute of Digestive Disease, Gastroenterology and Hepatology, Shatin, Hong KongJohns Hopkins Medical Institutions, Gastroenterology and Hepatology, Baltimore, Maryland, United StatesJohns Hopkins Medical Institutions, Gastroenterology and Hepatology, Baltimore, Maryland, United StatesShowa University Northern Yokohama Hospital, Digestive Disease Center, Yokohama, JapanJohns Hopkins Medical Institutions, Gastroenterology and Hepatology, Baltimore, Maryland, United StatesBackground and study aims: Type III achalasia is characterized by rapidly propagating pressurization attributable to spastic contractions. Although laparoscopic Heller myotomy (LHM) is the current gold standard management for type III achalasia, peroral endoscopic myotomy (POEM) is conceivably superior because it allows for a longer myotomy. Our aims were to compare the efficacy and safety of POEM with LHM for type III achalasia patients. Patients and methods: A retrospective study of 49 patients who underwent POEM for type III achalasia across eight centers were compared to 26 patients who underwent LHM at a single institution. Procedural data were abstracted and pre- and post-procedural symptoms were recorded. Clinical response was defined by improvement of symptoms and decrease in Eckardt stage to ≤ 1. Secondary outcomes included length of myotomy, procedure duration, length of hospital stay, and rate of adverse events. Results: Clinical response was significantly more frequent in the POEM cohort (98.0 % vs 80.8 %; P = 0.01). POEM patients had significantly shorter mean procedure time than LHM patients (102 min vs 264 min; P < 0.01) despite longer length of myotomy (16 cm vs 8 cm; P < 0.01). There was no significant difference between POEM and LHM in the length of hospital stay (3.3 days vs 3.2 days; P = 0.68), respectively. Rate of adverse events was significantly less in the POEM group (6 % vs 27 %; P < 0.01). Conclusions: POEM allows for a longer myotomy than LHM, which may result in improved clinical outcomes. POEM appears to be an effective and safe alternative to LHM in patients with type III achalasia.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1391668 |
| spellingShingle | Vivek Kumbhari Alan H Tieu Manabu Onimaru Mohammad H. El Zein Ezra N. Teitelbaum Michael B. Ujiki Matthew E. Gitelis Rani J. Modayil Eric S. Hungness Stavros N. Stavropoulos Hiro Shiwaku Rastislav Kunda Philip Chiu Payal Saxena Ahmed A. Messallam Haruhiro Inoue Mouen A. Khashab Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study Endoscopy International Open |
| title | Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study |
| title_full | Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study |
| title_fullStr | Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study |
| title_full_unstemmed | Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study |
| title_short | Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study |
| title_sort | peroral endoscopic myotomy poem vs laparoscopic heller myotomy lhm for the treatment of type iii achalasia in 75 patients a multicenter comparative study |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1391668 |
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