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Esophageal myotomy

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https://www.readbyqxmd.com/read/28534521/comprehensive-analysis-of-adverse-events-associated-with-per-oral-endoscopic-myotomy-in-1826-patients-an-international-multicenter-study
#1
Yamile Haito-Chavez, Haruhiro Inoue, Kristin W Beard, Peter V Draganov, Michael Ujiki, Burkhard H A Rahden, Pankaj N Desai, Mathieu Pioche, Bu Hayee, Amyn Haji, Payal Saxena, Kevin Reavis, Manabu Onimaru, Valerio Balassone, Jun Nakamura, Yoshitaka Hata, Dennis Yang, Davinderbir Pannu, Ali Abbas, Yaseen B Perbtani, Lava Y Patel, Jorg Filser, Sabine Roman, Jerome Rivory, Francois Mion, Thierry Ponchon, Silvana Perretta, Vivien Wong, Roberta Maselli, Saowanee Ngamruengphong, Yen-I Chen, Majidah Bukhari, Gulara Hajiyeva, Amr Ismail, Renata Pieratti, Vivek Kumbhari, Gerson Galdos-Cardenas, Alessandro Repici, Mouen A Khashab
OBJECTIVES: The safety of peroral endoscopic myotomy (POEM) is still debated since comprehensive analysis of adverse events (AEs) associated with the procedure in large multicenter cohort studies has not been performed. To study (1) the prevalence of AEs and (2) factors associated with occurrence of AEs in patients undergoing POEM. METHODS: Patients who underwent POEM at 12 tertiary-care centers between 2009 and 2015 were included in this case-control study. Cases were defined by the occurrence of any AE related to the POEM procedure...
May 23, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28528063/an-involuntary-and-unexpected-treatment-of-nutcracker-esophagus
#2
Diane Mege, Alban Benezech, Henri de Lesquen, Véronique Vitton, Pascal-Alexandre Thomas
A 76-year-old woman complained of painful dysphagia and loss of weight. Esophagoscopy results were negative, whereas computed tomography (CT) disclosed a 25-mm mediastinal tumor without a connection to the esophagus. A diagnosis of nutcracker esophagus was made on high-resolution esophageal manometry. Peroral endoscopic esophageal myotomy failed to improve the symptoms. Right video thoracoscopy allowed resection of the tumor, which looked like a neurogenic tumor of the posterior mediastinum that developed from the right vagus nerve...
June 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28496526/changing-trends-in-age-gender-racial-distribution-and-inpatient-burden-of-achalasia
#3
Vaibhav Wadhwa, Prashanthi N Thota, Malav P Parikh, Rocio Lopez, Madhusudhan R Sanaka
BACKGROUND: Achalasia is an idiopathic esophageal motility disorder characterized by dysphagia, regurgitation, chest discomfort and weight loss. The aim of this study was to evaluate the temporal trends in demographic variables, interventions, and inpatient burden in achalasia-related hospitalizations. METHODS: We evaluated the National Inpatient Sample Database (NIS) for all patients in whom achalasia (ICD-9 code: 530.0) was the principal discharge diagnosis from 1997 to 2013...
April 2017: Gastroenterology Research
https://www.readbyqxmd.com/read/28484733/per-oral-endoscopic-myotomy-for-achalasia-cardia-outcomes-in-over-400-consecutive-patients
#4
Zaheer Nabi, Mohan Ramchandani, Radhika Chavan, Rakesh Kalapala, Santosh Darisetty, Guduru Venkat Rao, Nageshwar Reddy
Background and study aims Per-oral endoscopic myotomy (POEM) has emerged as an efficacious treatment modality for the management of achalasia cardia (AC) and non-achalasia spastic esophageal motility disorders. Initial results are encouraging. We analyzed the safety and efficacy of POEM in a large cohort of patients with AC. Patients and methods The data from patients who underwent POEM (from January 2013 to June 2016) was prospectively collected and analyzed. Clinical success was defined as Eckardt score ≤ 3 after POEM procedure...
May 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/28475741/clinical-presentation-and-disease-course-of-patients-with-esophagogastric-junction-outflow-obstruction
#5
K L Lynch, Y-X Yang, D C Metz, G W Falk
Esophagogastric junction outflow obstruction, characterized by preserved peristalsis in conjunction with an elevated integrated relaxation pressure, can result from specific anatomic variants or may represent achalasia in evolution. There is limited information on the clinical significance of this diagnosis. The aim of this study is to describe the clinical characteristics and outcomes in our cohort of patients with esophagogastric junction outflow obstruction.Consecutive adult patients who had undergone high-resolution esophageal manometry between February 2013 and November 2015 with a diagnosis of esophagogastric junction outflow obstruction were identified...
June 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/28472834/gastroesophageal-reflux-after-peroral-endoscopic-myotomy-a-multicenter-case-control-study
#6
Vivek Kumbhari, Pietro Familiari, Niels Christian Bjerregaard, Mathieu Pioche, Edward Jones, Weon Jin Ko, Bu Hayee, Anna Cali, Saowanee Ngamruengphong, Francois Mion, Ruben Hernaez, Sabine Roman, Alan H Tieu, Mohamad El Zein, Tokunbo Ajayi, Amyn Haji, Joo Young Cho, Jeffrey Hazey, Kyle A Perry, Thierry Ponchon, Rastislav Kunda, Guido Costamagna, Mouen A Khashab
Background and study aims The variables associated with gastroesophageal reflux (GER) after peroral endoscopic myotomy (POEM) are largely unknown. This study aimed to: 1) identify the prevalence of reflux esophagitis and asymptomatic GER in patients who underwent POEM, and 2) evaluate patient and intraprocedural variables associated with post-POEM GER. Patients and methods All patients who underwent POEM and subsequent objective testing for GER (pH study with or without upper gastrointestinal [GI] endoscopy) at seven tertiary academic centers (one Asian, two US, four European) were included...
May 4, 2017: Endoscopy
https://www.readbyqxmd.com/read/28451814/the-relationship-between-manometric-subtype-and-outcomes-of-surgical-treatment-for-patients-with-achalasia-achalasia-manometric-subtypes
#7
Oscar Maximiliano Crespin, Roger Perry Tatum, Keliang Xiao, Ana Valeria Martin, Saurabh Khandelwal, Carlos Alberto Pellegrini, Brant Kurt Oelschlager
BACKGROUND: The Chicago Classification describes three distinct subtypes of achalasia and it appears to be a promising tool in predicting results of treatment with standard Heller Myotomy. The aim of this study is to analyze the outcomes of surgical treatment for achalasia using an extended Heller myotomy for each subtype and to identify additional parameters that may predict the success of therapy. METHODS: 72 consecutive patients with achalasia were evaluated at the University of Washington between 2008 and 2013...
April 27, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28446979/zenker-s-diverticulum-flexible-versus-rigid-repair
#8
REVIEW
Kristen Beard, Lee L Swanström
Zenker's diverticula (ZDs) are a relatively common cause of cervical dysphagia. Diagnosis is best by a good upper GI exam though upper endoscopy should be performed as well. Treatment is either by open, transcervical approaches or trans-oral. Over the past 20 years, transoral approach has mostly replace transcervical approaches due to less pain, no scarring and a rapid recovery. Transoral approaches are either using rigid access or flexible endoscopy. Today, the most common approach is transoral stapling using a 12 mm laparoscopic linear cutting stapler...
March 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28446976/per-oral-endoscopic-myotomy-for-achalasia
#9
REVIEW
Steven R DeMeester
Symptoms in patients with achalasia are produced by outflow obstruction at the level of the lower esophageal sphincter (LES). As a consequence of neural destruction the LES does not undergo normal swallow-induced relaxation. In addition, the esophageal body loses normal peristaltic function and esophageal emptying is on the basis of gravity. All therapies for achalasia are palliative in that normal LES or esophageal body function cannot be restored. The efficacy of any therapy for achalasia is directly related to its ability to reduce the outflow obstruction at the LES...
March 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28441166/minimally-invasive-organ-preserving-surgery-for-large-submucosal-tumors-in-the-abdominal-esophagus
#10
Eiji Kanehira, Takashi Tanida, Aya Kamei, Kodai Takahashi
BACKGROUND: Surgical resection of submucosal tumors (SMTs) in the abdominal esophagus is not standardized. Enucleation may be a minimally invasive option, whereas its oncological validity is not very clear. Moreover, how to treat the esophageal wall defect after enucleation and necessity of additional antireflux procedure are also undetermined. METHODS: In 13 patients with a SMT originating the abdominal esophagus laparoscopic enucleation was performed with preserving the integrity of submucosa...
April 24, 2017: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
https://www.readbyqxmd.com/read/28426463/treatments-for-achalasia-in-2017-how-to-choose-among-them
#11
Peter J Kahrilas, John E Pandolfino
PURPOSE OF REVIEW: To review recent advances in achalasia diagnostics and therapeutics. RECENT FINDINGS: The cardinal feature of achalasia, impaired lower esophageal sphincter (LES) relaxation, can occur in association with varied patterns of esophageal contractility. The Chicago Classification distinguishes among these as follows: without contractility (type I), with panesophageal pressurization (type II), with premature (spastic) distal esophageal contractions (type III), or even with preserved peristalsis [esophagogastric junction (EGJ) outlet obstruction]...
April 19, 2017: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/28416923/esophageal-achalasia-predictive-value-of-preoperative-resting-pressure-of-les-correlated-with-type-of-fundoplication
#12
Antonio Tancredi, Antonello Cuttitta, Roberto Scaramuzzi, Gerardo Scaramuzzi, Marco Taurchini
OBJECTIVE: The aim of the present study is to show the predictive value of the preoperative resting pressure of the lower esophageal sphincter (LES) correlated with the type of fundoplication (Nissen or Dor) after Heller myotomy in our series. MATERIALS AND METHODS: From January 1998 to June 2010, 88 patients affected by esophageal achalasia underwent surgery at our unit. However, our study focused on a sample of 36 patients, because many data were lost or was never recorded...
February 2017: Eurasian Journal of Medicine
https://www.readbyqxmd.com/read/28411346/peroral-endoscopic-myotomy-compared-with-pneumatic-dilation-for-newly-diagnosed-achalasia
#13
Fandong Meng, Peng Li, Yongjun Wang, Ming Ji, Yongdong Wu, Li Yu, Yinglin Niu, Fujing Lv, Wei Li, Wenyan Li, Huihong Zhai, Shanshan Wu, Shutian Zhang
BACKGROUND: This study retrospectively compared the safety and efficacy of two endoscopic techniques for treating newly diagnosed achalasia, pneumatic dilation (PD), and peroral endoscopic myotomy (POEM). METHODS: Demographics, clinical and manometric data, and outcomes were collected from the medical records of patients who received POEM or PD as the primary therapy for achalasia at our hospital from January 2012 to August 2015. RESULTS: Of 72 patients, 32 and 40 received POEM and PD, respectively...
April 14, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28393437/what-is-the-clinical-significance-of-esophagogastric-junction-outflow-obstruction-evaluation-of-60-patients-at-a-tertiary-referral-center
#14
F C Okeke, S Raja, K L Lynch, S Dhalla, M Nandwani, E M Stein, B Chander Roland, M A Khashab, P Saxena, V Kumbhari, N K Ahuja, J O Clarke
BACKGROUND: Esophagogastric junction (EGJ) outflow obstruction (EGJOO) is characterized by impaired EGJ relaxation with intact or weak peristalsis. Our aims were to evaluate: (i) prevalence, (ii) yield of fluoroscopy, endoscopy, and endoscopic ultrasound (EUS), (iii) outcomes, and (iv) whether this data differed based on quantitative EGJ relaxation. METHODS: Studies that met criteria for EGJOO were identified. Demographics, encounters, endoscopy, radiology, treatment decisions, and outcomes were extracted...
June 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/28390804/open-vs-endoscopic-cricopharyngeal-myotomy-is-there-a-difference
#15
Colin Huntley, Maurits Boon, Joseph Spiegel
INTRODUCTION: The upper esophageal sphincter (UES) is composed largely of the cricopharyngeus muscle (CP) and acts as the gatekeeper to the esophagus. There are multiple methods of treating UES dysfunction, but myotomy has been shown to be the most definitive means. We aim to evaluate the difference between open and endoscopic CP myotomy (CPM). METHODS: A retrospective review of all patients undergoing endoscopic and open CPM was undertaken. We recorded demographic, clinical, operative, hospital, and postoperative data for both groups from January 2010-March 2015...
March 31, 2017: American Journal of Otolaryngology
https://www.readbyqxmd.com/read/28375487/the-role-of-heller-myotomy-and-poem-for-nonachalasia-motility-disorders
#16
F Schlottmann, N J Shaheen, R D Madanick, M 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 such as Diffuse Esophageal Spasm (DES), Nutcracker Esophagus (NE) and the Hypertensive Lower Esophageal Sphincter (HTN-LES). Most patients with DES and HTN-LES who complain of dysphagia improve after a myotomy. Patients with NE whose main complaint is chest pain, often do not have relief of the pain and can even develop dysphagia as a consequence of the myotomy...
April 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/28375480/same-day-discharge-in-benign-esophageal-surgery-a-prospective-cohort-study
#17
A Desbeaux, C Gronnier, G Piessen, M Vanderbeken, N Ruolt, J-P Triboulet, C Mariette
Day-case esophageal surgery has been demonstrated to be safe in small prospective cohorts and only for laparoscopic fundoplication. The aims of this study are to assess the feasibility and safety of a large series of esophageal day-case surgeries, including laparoscopic Nissen fundoplication (LNF), Zenker diverticulectomy (ZD), and laparoscopic Heller myotomy (LHM) and to compare the outcomes among three procedures.This was a prospective, observational study of selected patients who underwent day-case LNF, ZD, and LHM between 2003 and 2013...
April 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/28375443/long-term-outcomes-of-peroral-endoscopic-myotomy-for-patients-with-achalasia-a-retrospective-single-center-study
#18
H Guo, H Yang, X Zhang, L Wang, Y Lv, X Zou, T Ling
Peroral endoscopic myotomy (POEM) has been widely applied to the treatment of achalasia. The aim of this study is to retrospectively investigate the long-term outcome of POEM in patients with achalasia. Patients undergoing POEM at our center with a minimum follow-up of 3 years were enrolled in this study. Relief of patients' symptom was defined as the primary outcome. Secondary outcomes included lower esophageal sphincter pressure, esophageal emptying, symptoms relapse, and clinical reflux adverse events. The Chi-square test was performed to determine the potential predictors of surgical failure...
May 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/28375437/achalasia-an-unnecessary-long-way-to-diagnosis
#19
S Niebisch, E Hadzijusufovic, M Mehdorn, M Müller, U Scheuermann, O Lyros, H G Schulz, B Jansen-Winkeln, H Lang, I Gockel
Although achalasia presents with typical symptoms such as dysphagia, regurgitation, weight loss, and atypical chest pain, the time until first diagnosis often takes years and is frustrating for patients and nevertheless associated with high costs for the healthcare system. A total of 563 patients were interviewed with confirmed diagnosis of achalasia regarding their symptoms leading to diagnosis along with past clinical examinations and treatments. Included were patients who had undergone their medical investigations in Germany...
May 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/28359500/uniportal-video-assisted-thoracoscopic-surgery-resection-of-a-giant-midesophageal-diverticulum
#20
Francesco Paolo Caronia, Alfonso Fiorelli, Mario Santini, Attilio Ignazio Lo Monte
We describe a new video-assisted technique for the management of a giant midesophageal diverticulum using a single 5-cm port. It maintained the same principles of the traditional open technique as diverticulectomy, myotomy, and fundoplication. The better visualization of the main esophageal body, diverticulum, and esophagogastric junction and the better alignment of the stapler cartridge to the longitudinal axis of the esophagus are all technical factors supporting our procedure. Heavily calcified mediastinal lymph nodes and diffuse pleural adhesions are the main contraindications...
April 2017: Annals of Thoracic Surgery
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