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Efficacy of per-oral endoscopic myotomy for the treatment of non-achalasia esophageal motor disorders

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Abstract

Introduction

Per-oral endoscopic myotomy (POEM) is effective in achalasia. The objective of this study was to evaluate the short-term clinical efficacy of POEM in non-achalasia esophageal motility disorders (NAEMD).

Patients and methods

Patients with NAEMD diagnosed by high-resolution manometry were included in a retrospective multicentric study. For each individual case, two controls paired on gender and age were matched: one with type I/II achalasia and one with type III achalasia. The clinical response, defined by an Eckardt score ≤ 3, was assessed at 3 and 6 months.

Results

Ninety patients (mean age 66 years, 57 men) were included, 30 patients with NAEMD (13 jackhammer esophagus, 6 spastic esophageal disorders, 4 nutcracker esophagus, and 7 esophagogastric junction obstruction), 30 patients with type I–II achalasia, and 30 patients with type III achalasia. The 3-month response rates were 80% (24/30), 90% (27/30), and 100% (30/30) in NAEMD, type I–II achalasia and type III achalasia, respectively (p < 0.01). Eckardt scores improved from preoperative baseline in all groups (median scores 2.0 after POEM vs. 6.5 before POEM, 1.3 vs. 7.2, and 0.5 vs. 6.1 in NAEMD, type I//I and Type III, respectively). No predictive factor of response was identified. In NAEMD patients, there was a significant improvement of dysphagia, regurgitation, and chest pain scores. The 6-month response rates were 63.2% (12/19), 95.5% (21/22), and 87.0% (20/23) in NAEMD, type I–II achalasia and type III achalasia, respectively (p = 0.03).

Conclusion

Although less effective than in achalasia, POEM is an effective treatment for NAEMD. Long-term follow-up data are needed to further confirm that POEM may be a valid treatment of NAEMD.

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Authors and Affiliations

  1. CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux; INSERM CIC 1401, Bordeaux, France

    Lucie Bernardot, Julien Vergniol, Edouard Chabrun & Frank Zerbib

  2. Hospices Civils de Lyon, Hôpital E Herriot, Gastroenterology, Université de Lyon; Inserm U1032, LabTAU, Lyon, France

    Sabine Roman, Mathieu Pioche & Thierry Ponchon

  3. Gastroenterology Department, AP-HP, Hôpital Cochin, Paris, France

    Maximilien Barret, Stanislas Chaussade & Frédéric Prat

  4. Gastroenterology Department, AP-HM, Hôpital Nord, Marseille, France

    Véronique Vitton, Jean-Michel Gonzalez & Marc Barthet

  5. Gastroenterology Department, CHU de Rennes, Rennes, France

    Timothée Wallenhorst

  6. Gastroenterology and Hepatology Department, Centre Medico-Chirurgical Magellan Haut-Lévêque Hospital, CHU de Bordeaux, Avenue Magellan, 33600, Pessac, France

    Frank Zerbib

Authors
  1. Lucie Bernardot
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  2. Sabine Roman
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  3. Maximilien Barret
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  4. Véronique Vitton
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  5. Timothée Wallenhorst
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  6. Mathieu Pioche
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  7. Stanislas Chaussade
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  8. Jean-Michel Gonzalez
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  9. Thierry Ponchon
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  10. Frédéric Prat
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  11. Marc Barthet
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  12. Julien Vergniol
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  13. Edouard Chabrun
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  14. Frank Zerbib
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Corresponding author

Correspondence to Frank Zerbib.

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Disclosures

S. Roman: Medtronic, Diversatek, Mayoli Spindler, Biocodex, M. Barret: Olympus, Cook, V. Vitton: Ipsen, Biocodex, Sanofi, Kyowa Kirin, Medtronic, T. Wallenhorst: Cook Medical, Fujifilm, Abbvie, Ipsen, M. Pioche: Boston Scientific, Olympus, Norgine, S. Chaussade: Fujifilm, Olympus, J.-M. Gonzalez: Cook, Cousin, T. Ponchon: Olympus, F. Prat: Boston Scientific, Olympus, Pentax, M. Barthet: Boston Scientific, J. Vergniol: none, E. Chabrun: Olympus, Boston Scientific, Cook Medical, Life Partners Europe, F. Zerbib: Takeda, Allergan, Biocodex, Vifor Pharma, Mayoli Spindler, Ipsen, Abbott, Reckitt Benckiser, Alfasigma. L. Bernardot: no conflict of interest or financial ties to disclose.

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Bernardot, L., Roman, S., Barret, M. et al. Efficacy of per-oral endoscopic myotomy for the treatment of non-achalasia esophageal motor disorders. Surg Endosc 34, 5508–5515 (2020). https://doi.org/10.1007/s00464-019-07348-y

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