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Esophageal myotomy

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https://www.readbyqxmd.com/read/29218664/cost-effectiveness-of-per-oral-endoscopic-myotomy-relative-to-laparoscopic-heller-myotomy-for-the-treatment-of-achalasia
#1
Erin K Greenleaf, Joshua S Winder, Christopher S Hollenbeak, Randy S Haluck, Abraham Mathew, Eric M Pauli
BACKGROUND: Per oral endoscopic myotomy (POEM) has recently emerged as a viable option relative to the classic approach of laparoscopic Heller myotomy (LHM) for the treatment of esophageal achalasia. In this cost-utility analysis of POEM and LHM, we hypothesized that POEM would be cost-effective relative to LHM. METHODS: A stochastic cost-utility analysis of treatment for achalasia was performed to determine the cost-effectiveness of POEM relative to LHM. Costs were estimated from the provider perspective and obtained from our institution's cost-accounting database...
December 7, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/29215957/peroral-endoscopic-myotomy-with-endoflip-and-double-endoscope-novel-techniques-for-achalasia-in-pediatric-population
#2
Fanny Yeung, Ian Y H Wong, Patrick H Y Chung, Kenneth K Y Wong, Simon Y K Law, Paul K H Tam
BACKGROUND: Experience of peroral endoscopic myotomy (POEM) for treatment of achalasia in pediatric population is limited with varying techniques in different centers. The accurate extent of submucosal tunneling into the gastric cardia and the adequacy of myotomy are the important determining factors to success of POEM. A majority of studies in pediatric population have described using submucosal dye injection for assessing the adequacy of myotomy, however, this is a rather crude and inaccurate method...
December 7, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/29208537/comprehensive-evaluation-of-the-learning-curve-for-peroral-endoscopic-myotomy
#3
Zuqiang Liu, Xiaocen Zhang, Wei Zhang, Yiqun Zhang, Weifeng Chen, Wenzheng Qin, Jianwei Hu, Mingyan Cai, Pinghong Zhou, Quanlin Li
BACKGROUND & AIMS: Peroral endoscopic myotomy (POEM) is a minimally invasive endoscopic surgical procedure that is effective in treatment for spastic esophageal motility disorders. However, little is known about the learning curve for endoscopists. We aimed to evaluate the effects of various factors on the POEM learning curve. METHODS: We performed a retrospective study of 1346 patients who underwent POEM for achalasia at Shanghai Zhongshan Hospital in China from August 2010 through July 2015...
December 2, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29155168/improved-assessment-of-bolus-clearance-in-patients-with-achalasia-using-high-resolution-impedance-manometry
#4
Dustin A Carlson, Claire A Beveridge, Zhiyue Lin, Michelle Balla, Dyanna Gregory, Michael Tye, Katherine Ritter, Peter J Kahrilas, John E Pandolfino
BACKGROUND & AIMS: Esophageal retention is typically evaluated by timed barium esophagram in patients treated for achalasia. Esophageal bolus clearance can also be evaluated using high-resolution impedance manometry. We evaluated the associations of conventional and novel high-resolution impedance manometry metrics, esophagram, and patient-reported outcomes (PRO) in achalasia. METHODS: We performed a prospective study of 70 patients with achalasia (20-81 years old, 30 female) treated by pneumatic dilation or myotomy who underwent follow-up evaluations from April 2013 through December 2015 (median 12 months after treatment; range, 3-183 months)...
November 15, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29142537/pneumatic-balloon-dilatation-for-achalasia-cardia-early-late-results-a-single-center-study
#5
S Waqar H Shah, Arshad K Butt, K Malik, Altaf Alam, Anwaar A Khan
Objective: Achalasia Cardia is treated by Pneumatic balloon dilatation, Heller's Myotomy and recently, by Peroral Esophagaeal Myotomy. This study reports the efficacy of pneumatic balloon dilatation as a non-surgical motility in achieving relief of dysphagia, clinical improvement and recurrence. Long-term complications were reported. Methods: Eight hundred ninety two adult achalasia patients of both genders were treated from January 1988 till December 2011, with pneumatic balloon (Rigiflex Microvasive(®)) dilatation, under fluoroscopy Barium swallow was obtained prior to and five minutes after dilatation to evaluate for efficacy of dilatation as well as for complications...
September 2017: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/29136670/submucosal-tunneling-endoscopic-myotomy-of-esophageal-epiphrenic-diverticulum
#6
Antônio Carlos Conrado, Luiz Eduardo Correia Miranda, Ana Clara Miranda, Diego Laurentino Lima
No abstract text is available yet for this article.
November 14, 2017: Endoscopy
https://www.readbyqxmd.com/read/29135385/redo-laparoscopic-heller-s-cardiomyotomy-for-recurrent-achalasia-is-laparoscopic-surgery-feasible
#7
Pranav Mandovra, Vishakha Kalikar, Ankur Patel, Roy V Patankar
BACKGROUND: Achalasia cardia is an esophageal motor disorder with raised lower esophageal sphincter (LES) pressure. Minimally invasive procedures have become the procedure of choice compared with conventional open surgery. After the primary surgery, recurrence or persistent symptoms have been noted in almost 10%-20% of cases. MATERIALS AND METHODS: In this case series, we share our experience with a series of 7 patients who presented to us from January 2010 to January 2017 for recurrent symptoms, following Heller's myotomy for achalasia cardia...
November 14, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/29134329/esophageal-motility-disorders-new-perspectives-from-high-resolution-manometry-and-histopathology
#8
REVIEW
Hiroki Sato, Kazuya Takahashi, Ken-Ichi Mizuno, Satoru Hashimoto, Junji Yokoyama, Go Hasegawa, Shuji Terai
High-resolution manometry (HRM) and peroral endoscopic myotomy (POEM) have contributed significantly to the field of esophageal motility disorders in recent years. The development of HRM has categorized various esophageal motility disorders with a focus on a diverse range of manometric anomalies. Additionally, the Chicago classification criteria is widely used for manometric diagnosis. Moreover, POEM was introduced as a minimally invasive radical therapy for achalasia and shows promise for other spastic esophageal motility disorders as well...
November 13, 2017: Journal of Gastroenterology
https://www.readbyqxmd.com/read/29122601/per-oral-endoscopic-myotomy-in-patients-with-or-without-prior-heller-myotomy-comparing-long-term-outcomes-in-a-large-u-s-single-center-cohort-with-videos
#9
Xiaocen Zhang, Rani J Modayil, David Friedel, Krishna C Gurram, Collin E Brathwaite, Sharon I Taylor, Maria M Kollarus, Sony Modayil, Bhawna Halwan, James H Grendell, Stavros N Stavropoulos
BACKGROUND AND AIMS: Heller myotomy (HM) is one of the most effective treatments for esophageal achalasia. However, failures do exist and the success rate tends to decrease with time. The efficacy of rescue treatments for patients with failed Heller is limited. A few small-scale studies have reported outcomes of per-oral endoscopic myotomy (POEM) in these patients. We conducted this study to systematically assess feasibility, safety, and efficacy of POEM on post-Heller patients. METHODS: Patients at least 3 months out from their POEM were selected from our prospective database: 318 consecutive POEMs performed from October 2009 to October 2016...
November 6, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29113005/is-integrated-relaxation-pressure-a-promising-predictor-of%C3%A2-effectiveness-of-peroral-endoscopic-myotomy-for-achalasia
#10
Hong Jin, Wei Zhao, Lili Zhang, Zhongqing Zheng, Tao Wang, Lanlan Wu, Bangmao Wang
Background Peroral endoscopic myotomy (POEM), first introduced in 2010, appears to be an effective therapy with few complications. This study aimed to find an optimal predictor of POEM outcome in achalasia. Methods We retrospectively assessed 89 patients diagnosed with achalasia who underwent POEM in General Hospital of Tianjin Medical University, from September 2012 to March 2015. Associations of Eckardt score with symptom duration, lower esophageal resting pressure, 4-second integrated relaxation pressure (4s-IRP), and maximum esophageal diameter were assessed before POEM...
November 7, 2017: Zeitschrift Für Gastroenterologie
https://www.readbyqxmd.com/read/29108981/outcomes-of-per-oral-endoscopic-myotomy-for-treatment-of-esophageal-achalasia-with-a-median-follow-up-of-49-months
#11
Quan-Lin Li, Qiu-Ning Wu, Xiao-Cen Zhang, Mei-Dong Xu, Wei Zhang, Shi-Yao Chen, Yun-Shi Zhong, Yi-Qun Zhang, Wei-Feng Chen, Wen-Zheng Qin, Jian-Wei Hu, Ming-Yan Cai, Li-Qing Yao, Ping-Hong Zhou
BACKGROUND AND AIMS: Per-oral endoscopic myotomy (POEM) has received wide acceptance as a highly effective and safe treatment for esophageal achalasia. Short-term and small-scale studies are ample but long-term large-scale studies are few. The aim of the study was to systematically analyze our long-term results of POEM, with particular emphasis on POEM failures and associated risk factors. METHODS: This is a single-center study. Consecutive POEM patients between August 2010 and December 2012 were included...
November 3, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29102729/gastroesophageal-reflux-disease-after-per-oral-endoscopic-myotomy-as-compared-with-heller-s-myotomy-with-fundoplication-a-systematic-review-with-meta-analysis
#12
REVIEW
Alessandro Repici, Lorenzo Fuccio, Roberta Maselli, Fabrizio Mazza, Loredana Correale, Daniele Mandolesi, Cristina Bellisario, Amrita Sethi, Mouen Kashab, Thomas Rösch, Cesare Hassan
BACKGROUND AND AIMS: Per-oral endoscopic myotomy (POEM) represents a less invasive alternative, as compared with conventional laparoscopic Heller's myotomy (LHM), for achalasia patients. It cannot be excluded, however, that the lack of fundoplication after POEM may result in a higher incidence of reflux disease, as compared with LHM. The aim was to conduct a systematic review of prospective studies reporting the incidence of reflux disease developed after POEM and LHM. METHODS: Literature search with electronic databases was performed (up to February 2017) to identify full articles on the incidence of gastro-esophageal reflux symptoms, endoscopic- and pH-monitoring-findings after POEM and LHM (with fundoplication)...
November 1, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29089698/laparoscopic-heller-s-myotomy-for-achalasia-cardia-one-time-treatment-in-developing-countries
#13
Vishal Gupta, Hunaid Hatimi, Saket Kumar, Abhijit Chandra
Laparoscopic Heller's myotomy (LHM) and endoscopic balloon dilation are two main treatment modalities for achalasia cardia. The best treatment modality in Indian setting, however, is still unknown. Here, we present the early results of LHM in achalasia. Hospital data from January 2009 to October 2013 was analyzed. Preoperative assessment included Eckardt's scoring, esophagogastroduodenoscopy, barium swallow examination, and esophageal manometry. Thirty-five patients (19 males and 16 females, median age 31 years, range 12-65) underwent LHM with partial fundoplication (with intraoperative endoscopy)...
October 2017: Indian Journal of Surgery
https://www.readbyqxmd.com/read/29078570/robotic-technological-aids-in-esophageal-surgery
#14
REVIEW
Fabrizio Rebecchi, Marco E Allaix, Mario Morino
Robotic technology is an emerging technology that has been developed in order to overcome some limitations of the standard laparoscopic approach, offering a stereoscopic three-dimensional visualization of the surgical field, increased maneuverability of the surgical tools with consequent increased movement accuracy and precision and improved ergonomics. It has been used for the surgical treatment of most benign esophageal disorders. More recently, it has been proposed also for patients with operable esophageal cancer...
2017: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29046776/the-safety-of-endoscopic-esophageal-procedures-under-general-anesthesia
#15
Go Eun Kim, Duk Kyung Kim, Ji Won Choi, In Sun Chung, Da Woon Jung
BACKGROUND: With the increasing demand for general anesthesia for endoscopic esophageal procedures, anesthesiologists should understand the clinical characteristics of post-procedural complications (PPCs). METHODS: We retrospectively investigated the incidence of and risk factors associated with PPCs of endoscopic esophageal procedures performed under general anesthesia from July 2013 to November 2016. The final analysis included 129 patients; 114 who underwent esophageal endoscopic dissection for esophageal tumors and 15 cases of peroral endoscopic myotomy for achalasia...
October 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29040483/results-of-surgical-treatment-of-cervical-esophageal-diverticula
#16
M Fraczek, A Karwowski, M Krawczyk, P M Paczkowski, B Pawlak, C Pszenny
On the basis of 20 years' experience, the authors present the immediate and long-term results of operative treatment of Zenker's diverticulum. Comparison of two methods of surgery - diverticulopexia (in 21 patients) and excision (in 16), both associated with upper esophageal sphincter myotomy - shows good immediate and longterm results (from 1 to 19 years), with disappearance of symptoms (dysphagia) in all patients. There was no perioperative mortality. Postoperative complications were most commonly of pulmonary origin and were observed in a third of patients in both groups...
November 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/29026325/laparoscopic-esophageal-myotomy-versus-pneumatic-dilation-in-the-treatment-of-idiopathic-achalasia-a-meta-analysis-of-randomized-controlled-trials
#17
Ramkaji Baniya, Sunil Upadhaya, Jahangir Khan, Suresh Kumar Subedi, Tabrez Shaik Mohammed, Balvant K Ganatra, Ghassan Bachuwa
BACKGROUND: Achalasia is a primary esophageal motility disorder of unknown etiology associated with abnormalities in peristalsis and lower esophageal sphincter relaxation. The disease is incurable; however, definitive treatment procedures like pneumatic dilation (PD)/balloon dilation and laparoscopic esophageal myotomy (LEM) are performed to relieve dysphagia and related symptoms. Currently, there is paucity of data comparing the outcomes of these procedures. The aim of this meta-analysis is to compare the short- and long-term success rates of PD and LEM...
2017: Clinical and Experimental Gastroenterology
https://www.readbyqxmd.com/read/29022068/esophagectomy-for-end-stage-achalasia-systematic-review-and-meta-analysis
#18
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/29019558/late-evaluation-of-dysphagia-after-heller-esophageal-myotomy-with-dor-fundoplication-for-achalasia
#19
Eduardo Rodrigues Zarco Câmara, Fernando Athayde Veloso Madureira, Delta Madureira, Renato Manganelli Salomão, Antonio Carlos Ribeiro Garrido Iglesias
BACKGROUND: All available treatments for achalasia are palliative and aimed to eliminate the flow resistance caused by a hypertensive lower esophageal sphincter. AIM: To analyze the positive and negative prognostic factors in the improvement of dysphagia and to evaluate quality of life in patients undergoing surgery to treat esophageal achalasia by comparing findings before, immediately after, and in long follow-up. METHODS: A total of 84 patients who underwent surgery for achalasia between 2001 and 2014 were retrospectively studied...
July 2017: Arquivos Brasileiros de Cirurgia Digestiva: ABCD, Brazilian Archives of Digestive 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-aga-institute
#20
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...
November 2017: Gastroenterology
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