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https://www.readbyqxmd.com/read/29467529/editorial-assessing-esophageal-function-in-achalasia-the-old-and-the-new
#1
Joseph R Triggs, Peter J Kahrilas
Achalasia is currently diagnosed according to the Chicago Classification v3.0 using high-resolution manometry and treatment focuses on disruption of the esophagogastric junction. A paper in this issue examines the utility of a timed barium esophagram with a 13 mm tablet challenge in differentiating achalasia from other diagnoses, finding 100% sensitivity. However, a large proportion of patients with non-achalasia dysphagia are also identified. Another paper in this issue proposes utilizing intraprocedure functional luminal imaging probe measurement during pneumatic dilation as a guide for upsizing dilations...
February 2018: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/29440962/focal-achalasia-case-report-and-review-of-the-literature
#2
Marcus Joachim Herzig, Radu Tutuian
Esophageal achalasia is a primary smooth muscle motility disorder specified by aperistalsis of the tubular esophagus in combination with a poorly relaxing and occasionally hypertensive lower esophageal sphincter (LES). These changes occur secondary to the destruction of the neural network coordinating esophageal peristalsis and LES relaxation (plexus myentericus). There are limited data on segmental involvement of the esophagus in adults. We report on the case of a 54-year-old man who presented initially with complete aperistalsis limited to the distal esophagus...
2018: Clujul Medical (1957)
https://www.readbyqxmd.com/read/29439587/clinical-management-of-pediatric-achalasia
#3
Marinde van Lennep, Michiel P van Wijk, Taher I Omari, Marc A Benninga, Maartje M J Singendonk
Achalasia is a rare esophageal motility disorder. Much of the literature is based on the adult population. In adults, guidance of therapeutic approach by manometric findings has led to improvement in patient outcome. Promising results have been achieved with novel therapies such as PerOral Endoscopic Myotomy (POEM). Areas covered: In this review, we provide an overview of the novel diagnostic and therapeutic tools for achalasia management and in what way they will relate to the future management of pediatric achalasia...
February 13, 2018: Expert Review of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29435819/expanding-role-of-third-space-endoscopy-in-the-management-of-esophageal-diseases
#4
REVIEW
Dennis Yang, Peter V Draganov
OPINION STATEMENT: "Third space" endoscopy, also commonly referred as submucosal endoscopy, is founded on the principle that the deeper layers of the gastrointestinal (GI) tract can be accessed by tunneling in the submucosal space without compromising the integrity of the overlying mucosa. Peroral endoscopic myotomy (POEM), endoscopic submucosal dissection (ESD), and submucosal tunneling endoscopic resection (STER) are innovative techniques within the field of third space endoscopy in the management of esophageal disorders...
February 12, 2018: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/29377271/-management-of-achalasia-cardia-expert-consensus-statements
#5
REVIEW
Mohan Ramchandani, D Nageshwar Reddy, Zaheer Nabi, Radhika Chouhan, Amol Bapaye, Shobhna Bhatia, Nilay Mehta, Pankaj Dhawan, Adarsh Chaudhary, Uday Ghoshal, Mathew Philip, Horst Neuhaus, Jacques Deviere, Haruhiro Inoue
Achalasia cardia (AC) is a frequently encountered motility disorder of the esophagus resulting from an irreversible degeneration of neurons. Treatment modalities are palliative in nature and there is no curative treatment available for AC as of now. Significant advancements have been made in the management of AC over last decade. The introduction of high resolution manometry (HRM) and per-oral endoscopic myotomy (POEM) have strengthened the diagnostic and therapeutic armamentarium of AC. HRM allows for the characterization of the type of achalasia which in turn has important therapeutic implications...
January 29, 2018: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29344561/self-expandable-metal-stent-placement-in-a-child-for-treatment-of-achalasia-after-failed-heller-myotomy
#6
Roberto Gugig, Guillermo Muñoz Jurado, Clifton Huang, Roberto Oleas, Carlos Robles-Medranda
Background and study aims  Childhood achalasia treatment remains inconclusive. What is next after myotomy failure? Repeated pneumatic-dilation put patients at greater risk of perforation with possible symptom recurrence. We report on a 12-year-old patient with a 1-year history of achalasia whom underwent Heller myotomy with fundoplication and recurred with symptoms 1 week after surgery. Pneumatic dilatation was considered but not done because of the risk of esophageal perforation. The decision was made to place a fully covered self-expanding metallic stent (FC-SEMS) for 3 months, which resolved the stenosis as confirmed by esophagram...
January 2018: Endoscopy International Open
https://www.readbyqxmd.com/read/29319024/what-to-do-when-heller-s-myotomy-fails-pneumatic-dilatation-laparoscopic-remyotomy-or-peroral-endoscopic-myotomy-a-systematic-review
#7
REVIEW
Sonia Fernández-Ananín, Arnulfo F Fernández, Carmen Balagué, David Sacoto, Eduardo Maria Targarona
BACKGROUND: Surgical treatment of achalasia fails in 10%-20% of patients. The most frequent responsible cause is the performance of an incomplete myotomy at primary surgery. The treatment when the failure happens is not well defined. In this study, we review and evaluate the possible treatments to be carried out when surgical myotomy fails. We define its benefits and results, with the purpose of defining a therapeutic algorithm. MATERIALS AND METHODS: The systematic review was performed following the guidelines established by the Meta-analysis of Observational Studies in Epidemiology statement...
January 10, 2018: Journal of Minimal Access Surgery
https://www.readbyqxmd.com/read/29319022/thoracoscopic-oesophagectomy-for-end-stage-achalasia
#8
Vaibhav Kumar Varshney, Subhash Chandra Soni, Manju Kumari, Pawan Kumar Garg, Ashok Puranik
Achalasia cardia is an oesophageal motility disorder characterised by aperistalsis and failure of relaxation of the lower oesophageal sphincter. The management is predominantly palliative with focus on addressing the sphincter that involves either pneumatic dilatation or Heller myotomy which relieves dysphagia in the majority of the cases. End-stage achalasia (ESA) is characterised by failed myotomy, massively dilated and tortuous oesophagus with nutritional deterioration due to progressive dysphagia and vomiting...
January 10, 2018: Journal of Minimal Access Surgery
https://www.readbyqxmd.com/read/29295508/additively-manufactured-pneumatically-driven-skin-electrodes
#9
Martin Schubert, Martin Schmidt, Paul Wolter, Hagen Malberg, Sebastian Zaunseder, Karlheinz Bock
Telemedicine focuses on improving the quality of health care, particularly in out-of-hospital settings. One of the most important applications is the continuous remote monitoring of vital parameters. Long-term monitoring of biopotentials requires skin-electrodes. State-of-the-art electrodes such as Ag/AgCl wet electrodes lead, especially during long-term application, to complications, e.g., skin irritations. This paper presents a low-cost, on-demand electrode approach for future long-term applications. The fully printed module comprises a polymeric substrate with electrodes on a flexible membrane, which establishes skin contact only for short time in case of measurement...
December 23, 2017: Materials
https://www.readbyqxmd.com/read/29206815/novel-intra-procedural-distensibility-measurement-accurately-predicts-immediate-outcome-of-pneumatic-dilatation-for-idiopathic-achalasia
#10
P I Wu, M M Szczesniak, P I Craig, L Choo, J Engelman, B Terkasher, J Hui, I J Cook
OBJECTIVES: Often 2-3 graduated pneumatic dilatations (PD) are required to treat achalasia as there is no current intra-procedural predictor of clinical response. Distensibility measurements using functional lumen imaging probe (FLIP) may provide an intra-procedural predictor of outcome. Our aim was to determine the optimal criterion for esophagogastric junction (EGJ) distensibility measurements during PD that predicts immediate clinical response. METHODS: EGJ distensibility was prospectively measured using FLIP immediately pre- and post-PD...
December 5, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/29201795/pneumatic-balloon-dilatation-for-achalasia-cardia-outcome-complications-success-and-long-term-follow-up
#11
Sudhir J Gupta, Nitin R Gaikwad, Amol R Samarth, Sonal R Gattewar
Background: Achalasia is a chronic disease that can be managed with effective endoscopic modalities. Aim: To evaluate the effectiveness of single setting of pneumatic balloon dilatation for achalasia and assess the long-term success and outcomes. Materials and methods: This is a retrospective study of all achalasia patients who underwent pneumatic balloon dilatation at our institute. Patients who could be contacted were inquired regarding their symptoms and dysphagia-free interval after dilatation...
July 2017: Euroasian Journal of Hepato-Gastroenterology
https://www.readbyqxmd.com/read/29155168/improved-assessment-of-bolus-clearance-in-patients-with-achalasia-using-high-resolution-impedance-manometry
#12
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/29144018/navigated-retrograde-endoscopic-myotomy-rem-for-the-treatment-of-therapy-resistant-achalasia
#13
K D Pham, R F Havre, T Langø, E F Hofstad, G A Tangen, R Mårvik, T Pham, O H Gilja, J G Hatlebakk, A Viste
BACKGROUND: In achalasia, muscle spasm may involve the proximal esophagus. When the muscle spasm is located in the proximal esophagus, conventional per oral endoscopic myotomy (POEM) may not be sufficient to relieve symptoms. In this paper, we describe retrograde endoscopic myotomy (REM) as a novel approach to perform myotomy of the proximal esophagus, with the application of a navigation tool for anatomical guidance during REM. We aim to evaluate the feasibility and safety of REM and usefulness of the navigation during REM...
November 16, 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/29142537/pneumatic-balloon-dilatation-for-achalasia-cardia-early-late-results-a-single-center-study
#14
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/29140553/outcomes-of-pneumatic-dilation-in-achalasia-extended-follow-up-of-more-than-25-years-with-a-focus-on-manometric-subtypes
#15
Michaela Müller, Christina Keck, Alexander J Eckardt, Sarah Werling, Till Wehrmann, Jochem König, Ines Gockel
BACKGROUND AND AIMS: Pneumatic dilation (PD) is the most popular non-surgical treatment for achalasia. This study investigated predicting factors, including manometric subtypes for symptom recurrence in the long-term, in patients with achalasia treated with a single PD. PATIENTS AND METHODS: Between 1983 and 2013, a total of 107 patients were treated initially with a single PD and included in this longitudinal cohort study. Outcomes were correlated with demographics, symptoms (Eckardt Score), esophagographic and manometric features...
November 15, 2017: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29089672/radiological-requirements-for-surgical-planning-in-cochlear-implant-candidates
#16
Mohamad Hasan Alam-Eldeen, Usama Mohamed Rashad, Al Hussein Awad Ali
OBJECTIVE: This study is concerned with clarification of radiological findings that should be addressed and reported in patients listed for cochlear implant (CI) operation. These findings may force a surgeon to consider modifications of the surgical approach by a CI surgeon. MATERIALS AND METHODS: The study was performed from January 2015 to January 2016. It included 50 patients with severe-to-profound sensorineural hearing loss who fulfilled the criteria for CI...
July 2017: Indian Journal of Radiology & Imaging
https://www.readbyqxmd.com/read/29038193/recurrent-episodes-of-esophageal-candidiasis-without-dysphagia-post-guillain-barr%C3%A3-syndrome-an-unusual-presentation-of-achalasia
#17
Daniel Runggaldier, Michael Fried, Daniel Pohl
Here, we present a case of a 50-year-old male with a history of a Guillain-Barré-syndrome, who was referred to our clinic with recurrent esophageal candidiasis and long-standing intermittent retrosternal cramps for further evaluation. Other symptoms such as dysphagia, regurgitations and weight loss were denied, and prior repeated endoscopy was otherwise unremarkable. Using high resolution impedance manometry, we could demonstrate a panesophageal pressure increase on water swallows and complete aperistalsis of the tubular esophagus, indicating achalasia type II...
October 15, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29026592/yield-of-prolonged-wireless-ph-monitoring-in-achalasia-patients-successfully-treated-with-pneumatic-dilation
#18
Aurelio Mauro, Marianna Franchina, Alessandra Elvevi, Delia Pugliese, Andrea Tenca, Dario Conte, Roberto Penagini
BACKGROUND: Gastro-oesophageal reflux disease (GORD) is a long-term complication of achalasia treatments. The aim of our study was to evaluate the yield of prolonged wireless pH monitoring in patients with successfully treated achalasia and its influence on proton pump inhibitor (PPI) use. METHODS: Twenty-five patients with achalasia who underwent prolonged wireless pH monitoring after a successful treatment with pneumatic dilation were enrolled. pH variables were analysed in the first 24 hours of monitoring to determine if tracings were indicative of GORD; the same variables were analysed in the following 24-hour period in order to obtain a worst-day diagnosis of GORD...
October 2017: United European Gastroenterology Journal
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
#19
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/29024314/clinicomanometric-factors-associated-with-clinically-relevant-esophagogastric-junction-outflow-obstruction-from-the-sandhill-high-resolution-manometry-system
#20
B G Song, Y W Min, H Lee, B-H Min, J H Lee, P-L Rhee, J J Kim
BACKGROUND: Integrated relaxation pressure (IRP) is a key metric for diagnosing esophagogastric junction outflow obstruction (EGJOO). However, its normal value might be different according to the manufacturer of high-resolution manometry (HRM). This study aimed to investigate optimal value of IRP for diagnosing EGJOO in Sandhill HRM and to find clinicomanometric variables to segregate clinically relevant EGJOO. METHODS: We analyzed 262 consecutive subjects who underwent HRM between June 2011 and December 2016 showing elevated median IRP (> 15 mm Hg) but did not satisfy criteria for achalasia...
October 10, 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
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