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achalasia review

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https://www.readbyqxmd.com/read/29022068/esophagectomy-for-end-stage-achalasia-systematic-review-and-meta-analysis
#1
REVIEW
Alberto Aiolfi, Emanuele Asti, Gianluca Bonitta, Luigi Bonavina
BACKGROUND: Indications for surgery and clinical outcomes of esophagectomy in the management of end-stage achalasia are not clearly defined. The aim of this systematic review and meta-analysis was to provide evidence-based information to help in the decision-making and in the choice of surgical technique. METHODS: An extensive literature search was conducted to identify all reports on esophagectomy for end-stage achalasia patients over the past three decades. MEDLINE, Embase and Cochrane databases were thoroughly consulted matching the terms "achalasia," "end-stage achalasia," "esophagectomy" and "esophageal resection" with "AND" and "OR...
October 11, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28989059/clinical-practice-update-the-use-of-per-oral-endoscopic-myotomy-in-achalasia-expert-review-and-best-practice-advice%C3%A2-from-the-american-gastroenterological-association
#2
REVIEW
Peter J Kahrilas, David Katzka, Joel E Richter
The purpose of this review is to describe a place for per-oral endoscopic myotomy (POEM) among the currently available robust treatments for achalasia. The recommendations outlined in this review are based on expert opinion and on relevant publications from PubMed and EMbase. The Clinical Practice Updates Committee of the American Gastroenterological Association proposes the following recommendations: 1) in determining the need for achalasia therapy, patient-specific parameters (Chicago Classification subtype, comorbidities, early vs late disease, primary or secondary causes) should be considered along with published efficacy data; 2) given the complexity of this procedure, POEM should be performed by experienced physicians in high-volume centers because an estimated 20-40 procedures are needed to achieve competence; 3) if the expertise is available, POEM should be considered as primary therapy for type III achalasia; 4) if the expertise is available, POEM should be considered as treatment option comparable with laparoscopic Heller myotomy for any of the achalasia syndromes; and 5) post-POEM patients should be considered high risk to develop reflux esophagitis and advised of the management considerations (potential indefinite proton pump inhibitor therapy and/or surveillance endoscopy) of this before undergoing the procedure...
October 6, 2017: Gastroenterology
https://www.readbyqxmd.com/read/28958274/age-and-achalasia-how-does-age-affect-patient-presentation-hospital-course-and-surgical-outcomes
#3
Darrell J Downs, Giavanna Jadick, Forat Swaid, Sharona B Ross, Alexander S Rosemurgy
Heller myotomy is the "gold-standard" therapy for achalasia, alleviating symptoms by defunctionalizing the lower esophageal sphincter mechanism. Observation has suggested many differences between young and old patients with achalasia, raising the question: is achalasia in younger patients a different disorder than it is in older patients? This study was undertaken to answer this question. With Institutional Review Board approval, 648 patients undergoing laparoscopic Heller myotomy from 1992-2016 were prospectively followed up...
September 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28881885/igg4-related-disease-involving-the-esophagus-a-clinicopathological-study
#4
I Obiorah, A Hussain, C Palese, N Azumi, S Benjamin, M Ozdemirli
Immunoglobulin G4 (IgG4)-related disease is a recently coined systemic disease characterized by specific histopathologic findings of an intense lymphoplasmacytic infiltrate, storiform fibrosis, and obliterative phlebitis in the presence of predominant IgG4-positive plasma cells. Although IgG4-related disease has been described in many organs, involvement of the esophagus is very rare. In this study, we describe the clinicopathologic characteristics of eight patients with IgG4-related esophagitis. We evaluated chronic esophagitis specimens with lymphoplasmacytic infiltrate obtained over the past 6 years (from January 2011 to February 2017) using a chart review, pathologic examination, and IgG4 immunohistochemical staining...
December 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/28881880/trends-in-diagnoses-after-implementation-of-the-chicago-classification-for-esophageal-motility-disorders-v3-0-for-high-resolution-manometry-studies
#5
P Laing, A P Bress, J Fang, K Peterson, D G Adler, A J Gawron
To determine trends in the diagnostic distribution of esophageal motility disorders after implementation of the Chicago Classification Version 3.0 (CC V3.0) for interpretation of high-resolution manometry (HRM) studies compared to non-Chicago Classification criteria. Retrospective trends analysis of patients with an HRM study conducted at a single center from January 1, 2013 to September 30, 2015. The implementation of the CC V3.0 for manometry interpretation occurred in September 2014. Patient charts were manually reviewed for data collection including demographics and HRM diagnoses...
December 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/28881879/spectrum-of-esophageal-dysmotility-in-systemic-sclerosis-on-high-resolution-esophageal-manometry-as-defined-by-chicago-classification
#6
N Aggarwal, R Lopez, S Gabbard, N Wadhwa, P Devaki, P N Thota
The classic manometric findings in systemic sclerosis are aperistalsis of the esophageal body with hypotensive lower esophageal sphincter. These changes contribute to gastroesophageal reflux disease in these patients. With widespread use of high-resolution esophageal manometry, diverse abnormalities are seen. The aim of this study is to characterize esophageal dysmotility in patients with systemic sclerosis undergoing high-resolution esophageal manometry and compare demographic features and diagnostic test results among patients with varying degrees of esophageal dysmotility...
December 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/28867969/an-overview-of-achalasia-and-its-subtypes
#7
Dhyanesh A Patel, Brian M Lappas, Michael F Vaezi
Achalasia is one of the most studied esophageal motility disorders. However, the pathophysiology and reasons that patients develop achalasia are still unclear. Patients often present with dysphagia to solids and liquids, regurgitation, and varying degrees of weight loss. There is significant latency prior to diagnosis, which can have nutritional implications. The diagnosis is suspected based on clinical history and confirmed by esophageal high-resolution manometry testing. Esophagogastroduodenoscopy is necessary to rule out potential malignancy that can mimic achalasia...
July 2017: Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28859394/esophageal-achalasia-a-risk-factor-for-carcinoma-a-systematic-review-and-meta-analysis
#8
F Tustumi, W M Bernardo, J R M da Rocha, S Szachnowicz, F C Seguro, E T Bianchi, R A A Sallum, I Cecconello
Achalasia of the cardia is associated with an increased risk of esophageal carcinoma. The real burden of achalasia at the malignancy genesis is still a controversial issue. Therefore, there are no generally accepted recommendations on follow-up evaluation for achalasia patients. This study aims to estimate the risk of esophageal adenocarcinoma and squamous cell carcinoma in achalasia patients. We searched for association between carcinoma and esophageal achalasia in databases up to January 2017 to perform a systematic review and meta-analysis...
October 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/28815063/the-impact-of-flexible-endoscopy-in-esophageal-surgery
#9
REVIEW
Alejandro Nieponice, Fabio Nachman, Adolfo Badaloni, Franco Ciotola, Cecilia Zubieta, Mauricio Ramirez
Achalasia and Treatment of esophageal Adenocarcinoma are commonly associated to surgical resection. Newer technologies in interventional endoscopy gave way to a substantial paradigm shift in the management of these conditions. In the case of achalasia, endoscopic myotomy is rapidly displacing Heller's myotomy as the gold standard in many centers. Early stage neoplasia in Barrett's esophagus (BE) comprising high-grade dysplasia (HGD), intramucosal and, in some cases, submucosal carcinoma is now being treated without the need of esophagectomy...
July 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28730503/chicago-classification-of-esophageal-motility-disorders-lessons-learned
#10
REVIEW
W O A Rohof, A J Bredenoord
PURPOSE OF REVIEW: High-resolution manometry (HRM) is increasingly performed worldwide, to study esophageal motility. The Chicago classification is subsequently applied to interpret the manometric findings and facilitate a diagnosis of esophageal motility disorders. This review will discuss new insights regarding the diagnosis and management using the Chicago classification. RECENT FINDINGS: Recent studies have demonstrated that high-resolution manometry is superior to conventional manometry, and has a higher sensitivity to diagnose achalasia...
August 2017: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/28726147/stent-migration-following-endoscopic-suture-fixation-of-esophageal-self-expandable-metal-stents-a-systematic-review-and-meta-analysis
#11
Ryan Law, Anoop Prabhu, Larissa Fujii-Lau, Carol Shannon, Siddharth Singh
BACKGROUND: Covered self-expandable metal stents (SEMS) are utilized for the management of benign and malignant esophageal conditions; however, covered SEMS are prone to migration. Endoscopic suture fixation may mitigate the migration risk of covered esophageal SEMS. Hence, we conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of endoscopic suture fixation for covered esophageal SEMS. METHODS: Following PRISMA guidelines, we performed a systematic review from 2011 to 2016 to identify studies (case control/case series) reporting the technical success and migration rate of covered esophageal SEMS following endoscopic suture fixation...
July 19, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28724307/per-oral-endoscopic-myotomy-poem-a-new-endoscopic-treatment-for-achalasia
#12
Pablo Miranda García, Fernando Casals Seoane, Jean-Michel Gonzalez, Marc Barthet, Cecilio Santander Vaquero
BACKGROUND/AIMS: Per-oral endoscopic myotomy (POEM) is a new minimally invasive technique to treat achalasia. METHODS: We performed a review of the literature of POEM with a special focus on technical details and the results obtained with this technique in patients with achalasia and other esophageal motility disorders. RESULTS: Thousands of POEM procedures have been performed worldwide since its introduction in 2008. The procedure is based on the creation of a mucosal entry point in the proximal esophagus to reach the cardia through a submucosal tunnel and then perform a myotomy of the muscular layers of the cardia, esophagogastric junction and distal esophagus, as performed in a Heller myotomy...
October 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/28717439/achalasia-current-therapeutic-options
#13
REVIEW
Zubin Arora, Prashanthi N Thota, Madhusudhan R Sanaka
Achalasia is a chronic incurable esophageal motility disorder characterized by impaired lower esophageal sphincter (LES) relaxation and loss of esophageal peristalsis. Although rare, it is currently the most common primary esophageal motility disorder, with an annual incidence of around 1.6 per 100,000 persons and prevalence of around 10.8/100,000 persons. Symptoms of achalasia include dysphagia to both solids and liquids, regurgitation, aspiration, chest pain and weight loss. As the underlying etiology of achalasia remains unclear, there is currently no curative treatment for achalasia...
June 2017: Therapeutic Advances in Chronic Disease
https://www.readbyqxmd.com/read/28707343/peroral-endoscopic-myotomy-is-safe-and-effective-in-achalasia-patients-aged-older-than-60%C3%A2-years-compared-with-younger-patients
#14
Xiaowei Tang, Yutang Ren, Qiaoping Gao, Silin Huang, Jieqiong Zhou, Xiaofeng Zhang, Jianfeng Yang, Zhengjie Wei, Zhenyu Chen, Bo Jiang, Wei Gong
AIM: Peroral endoscopic myotomy (POEM) has been proven to be effective for treating achalasia, but there are limited data on POEM in elderly patients. We therefore aimed to assess the role of POEM for achalasia in patients aged ≥60 years. METHODS: All consecutive patients that underwent POEM between December 2011 and November 2015 at a single center were retrospectively reviewed. Patients aged ≥60 years were assigned to group A, whereas patients aged <60 years were assigned to group B...
July 14, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28665309/primary-esophageal-motility-disorders-beyond-achalasia
#15
REVIEW
Francisco Schlottmann, Marco G Patti
The best-defined primary esophageal motor disorder is achalasia. However, symptoms such as dysphagia, regurgitation and chest pain can be caused by other esophageal motility disorders. The Chicago classification introduced new manometric parameters and better defined esophageal motility disorders. Motility disorders beyond achalasia with the current classification are: esophagogastric junction outflow obstruction, major disorders of peristalsis (distal esophageal spasm, hypercontractile esophagus, absent contractility) and minor disorders of peristalsis (ineffective esophageal motility, fragmented peristalsis)...
June 30, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28658680/submucosal-fibrosis-in-achalasia-patients-is-a-rare-cause-of-aborted-peroral-endoscopic-myotomy-procedures
#16
Qiu-Ning Wu, Xiao-Yue Xu, Xiao-Cen Zhang, Mei-Dong Xu, Yi-Qun Zhang, Wei-Feng Chen, Ming-Yan Cai, Wen-Zheng Qin, Jian-Wei Hu, Li-Qing Yao, Quan-Lin Li, Ping-Hong Zhou
Background and aims Peroral endoscopic myotomy (POEM) is now an established treatment for esophageal achalasia. The standard protocol ensures a smooth operation in most patients, but technical challenges and failures exist and little is known about the incidence, causes, and impact of aborted procedures. Here, using a large patient cohort, we attempted to answer these questions. Methods All patients admitted for planned POEM between August 2010 and July 2015 underwent chart review. Aborted POEM was defined as the inability to finish the procedure after submucosal injection...
August 2017: Endoscopy
https://www.readbyqxmd.com/read/28617027/efficacy-of-peroral-endoscopic-myotomy-compared-with-other-invasive-treatment-options-for-the-different-esophageal-motor-disorders
#17
Fermín Estremera-Arévalo, Eduardo Albéniz, María Rullán, Irene Areste, Rosa Iglesias, Juan José Vila
INTRODUCTION: Peroral endoscopic myotomy (POEM) has been performed since 2008 on more than 5,000 patients. It has proven to be highly effective in the treatment of achalasia and has shown promising outcomes for other esophageal motility spastic disorders. METHODS: A literature review of the efficacy of POEM compared to the previous invasive treatments for different esophageal motility disorders was performed. The application in the pediatric and elderly populations and its role as a rescue therapy after other procedures are also outlined...
August 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/28575249/esophageal-distensibility-measurement-impact-on-clinical-management-and-procedure-length
#18
N K Ahuja, A Agnihotri, K L Lynch, D Hoo-Fatt, F Onyimba, M McKnight, F C Okeke, P Garcia, S Dhalla, E Stein, P J Pasricha, J O Clarke
Luminal distensibility measurement has demonstrated relevance to various disease processes, though its effects on clinical decision-making have been less well understood. This study aims to characterize the clinical impact of impedance planimetry measurement as well as the learning curve associated with its use in the esophagus. A single provider performed distensibility measurement in conjunction with upper endoscopy for a variety of clinical indications with the functional lumen imaging probe (FLIP) over a period of 21 months...
August 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/28566891/ling-classification-describes-endoscopic-progressive-process-of-achalasia-and-successful-peroral-endoscopy-myotomy-prevents-endoscopic-progression-of-achalasia
#19
Wen-Gang Zhang, En-Qiang Linghu, Ning-Li Chai, Hui-Kai Li
AIM: To verify the hypothesis that the Ling classification describes the endoscopic progressive process of achalasia and determine the ability of successful peroral endoscopic myotomy (POEM) to prevent endoscopic progression of achalasia. METHODS: We retrospectively reviewed the endoscopic findings, symptom duration, and manometric data in patients with achalasia. A total of 359 patients (197 women, 162 men) with a mean age of 42.1 years (range, 12-75 years) were evaluated...
May 14, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28549006/laparoscopic-heller-myotomy-versus-peroral-endoscopic-myotomy-poem-for-achalasia-a-systematic-review-and-meta-analysis
#20
Francisco Schlottmann, Daniel J Luckett, Jason Fine, Nicholas J Shaheen, Marco G Patti
OBJECTIVE: To compare the outcome of per oral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) for the treatment of esophageal achalasia. BACKGROUND: Over the last 2 decades, LHM has become the primary form of treatment in many centers. However, since the first description of POEM in 2010, this technique has widely disseminated, despite the absence of long-term results and randomized trials. METHODS: A systematic Medline literature search of articles on LHM and POEM for the treatment of achalasia was performed...
May 25, 2017: Annals of Surgery
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