Year 2016 / Volume 108 / Number 10
Original
Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged ≥ 65 years

637-641

DOI: 10.17235/reed.2016.4488/2016

Xuehong Wang, Yuyong Tan, Liang Lv, Hongyi Zhu, Yi Chu, Chenjie Li, Deliang Liu,

Abstract
Background and aim: Both peroral endoscopic myotomy (POEM) and pneumatic dilation (PD) has proved to be effective for treating achalasia in patients aged ≥ 65 years. However little is known about the comparison between POEM and PD. The aim of the study was to compare the safety and efficacy of POEM and PD for the treatment of achalasia in these patients. Methods: We retrospectively reviewed the medical records of patients aged 65 years-old or more who received POEM or PD for the treatment of achalasia at our hospital from January 2010 to December 2015, they were divided into the POEM group and the PD group. Demographics and data about safety and efficacy were collected retrospectively and compared between the two groups. Results: A total of 31 patients were enrolled, and 21 of them received POEM, while the other 10 received PD. The treatment success (Eckardt score ≤ 3) rate of POEM and PD at 3, 6, 12, 24 and 36 months after the treatment were comparable (p > 0.05). Treatment failure was noticed in 3 cases, 1 of them was in the POEM group and the other 2 in the PD group, there was no significant difference (p > 0.05). Multivariate analysis showed that sigmoid-type achalasia was a predictive factor of treatment failure. No severe complications were observed during operation and periodical follow-up. Conclusion: Short-term and intermediate efficacy of POEM and PD for treating achalasia in patients aged ≥ 65 years was comparable. A large scale, randomized study with long-term follow-up is necessary in order to make a definitive conclusion.
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References
1.Sonnenberg A. Hospitalization for achalasia in the United States 1997-2006. Dig Dis Sci 2009; 54: 1680-1685. DOI: 10.1007/s10620-009-0863-8
2.Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet 2014; 383: 83-93. DOI: 10.1016/S0140-6736(13)60651-0
3.Zarate N, Mearin F, Baldovino F, et al. Achalasia treatment in the elderly: is botulinum toxin injection the best option. Eur J Gastroenterol Hepatol 2002; 14(3): 285-90. DOI: 10.1097/00042737-200203000-00013
4.Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271. DOI: 10.1055/s-0029-1244080
5.Li CJ, Tan YY, Wang XH, et al. Peroral endoscopic myotomy for achalasia in patients aged >/= 65 years. World J Gastroenterol 2015; 21: 9175-9181. DOI: 10.3748/wjg.v21.i30.9175
6.Stavropoulos SN, Modayil RJ, Friedel D, et al. The International Per Oral Endoscopic Myotomy Survey (IPOEMS): a snapshot of the global POEM experience. Surg Endosc 2013; 27: 3322-3338. DOI: 10.1007/s00464-013-2913-8
7.Henderson RD. Esophageal motor disorders. Surg Clin North Am 1987; 67:
455-74.
8.Triadafilopoulos G, Aaronson M, Sackel S, et al. Medical treatment of esophageal achalasia. Double-blind crossover study with oral nifedipine, verapamil, and placebo. Dig Dis Sci 1991; 36: 260-267. DOI: 10.1007/bf01318193
9.Jung HE, Lee JS, Lee TH, et al. Long-term outcomes of pneumatic dilation versus botulinum toxin injection in patients with primary achalasia. Korean J Intern Med 2014; 29: 738-745. DOI: 10.3904/kjim.2014.29.6.727
10.Zhao H, Wan XJ, Yang CQ. Comparison of endoscopic pneumatic dilation with metal stent placement in the treatment of achalasia. J Dig Dis 2015; 16: 311-318. DOI: 10.1111/1751-2980.12241
11.Boeckxstaens GE, Annese V, des VSB, et al. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. N Engl J Med 2011; 364: 1807-1816. DOI: 10.1056/nejmoa1010502
12.Moonen A, Annese V, Belmans A, et al. Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut 2016; 65: 732-9. DOI: 10.1136/gutjnl-2015-310602
13.Karamanolis G, Sgouros S, Karatzias G, et al. Long-term outcome of pneumatic dilation in the treatment of achalasia. Am J Gastroenterol 2005; 100: 270-274. DOI: 10.1111/j.1572-0241.2005.50395_3.x
14.Katsinelos P, Kountouras J, Paroutoglou G, et al. Long-term results of pneumatic dilation for achalasia: a 15 years' experience. World J Gastroenterol 2005; 11: 5701-5705. DOI: 10.3748/wjg.v11.i36.5587
15.Farhoomand K, Connor JT, Richter JE, et al. Predictors of outcome of pneumatic dilation in achalasia. Clin Gastroenterol Hepatol 2004; 2: 389-394. DOI: 10.1016/s1542-3565(04)00123-5
16.Eckardt VF, Gockel I, Bernhard G. Pneumatic dilation for achalasia: late results of a prospective follow up investigation. Gut 2004; 53: 629-633. DOI: 10.1136/gut.2003.029298
17.Hulselmans M, Vanuytsel T, Degreef T, et al. Long-term outcome of pneumatic dilation in the treatment of achalasia. Clin Gastroenterol Hepatol 2010; 8: 30-35. DOI: 10.1016/j.cgh.2009.09.020
18.Karanicolas PJ, Smith SE, Inculet RI, et al. The cost of laparoscopic myotomy versus pneumatic dilatation for esophageal achalasia. Surg Endosc 2007; 21: 1198-1206. DOI: 10.1007/s00464-007-9364-z
19.O'Connor JB, Singer ME, Imperiale TF, et al. The cost-effectiveness of treatment strategies for achalasia. Dig Dis Sci 2002; 47: 1516-1525. DOI:
20.Anselmino M, Perdikis G, Hinder RA, et al. Heller myotomy is superior to dilatation for the treatment of early achalasia. Arch Surg 1997; 132(3): 233-40. DOI: 10.1001/archsurg.1997.01430270019002
21.Lynch KL, Pandolfino JE, Howden CW, et al. Major complications of pneumatic dilation and Heller myotomy for achalasia: single-center experience and systematic review of the literature. Am J Gastroenterol 2012; 107(12): 1817-25. DOI: 10.1038/ajg.2012.332
22.Katzka DA, Castell DO. Review article: an analysis of the efficacy, perforation rates and methods used in pneumatic dilation for achalasia. Aliment Pharmacol Ther 2011; 34(8): 832-9. DOI: 10.1111/j.1365-2036.2011.04816.x
23.Vigneswaran Y, Tanaka R, Gitelis M, et al. Quality of life assessment after peroral endoscopic myotomy. Surg Endosc 2015; 29: 1198-1202. DOI: 10.1007/s00464-014-3793-2
24.Liu XJ, Tan YY, Yang RQ, et al. The Outcomes and Quality of Life of Patients with Achalasia after Peroral Endoscopic Myotomy in the Short-Term. Ann Thorac Cardiovasc Surg 2015; 21: 507-512. DOI: 10.5761/atcs.oa.15-00066
25.Rohof WO, Salvador R, Annese V, et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology 2013; 144:718-725; quiz e13-14. DOI: 10.1053/j.gastro.2012.12.027
26.Zaninotto G, Costantini M, Portale G, et al. Etiology, diagnosis, and treatment of failures after laparoscopic Heller myotomy for achalasia. Ann Surg 2002; 235: 186-192. DOI: 10.1097/00000658-200202000-00005
27. Hu JW, Li QL, Zhou PH, Yao LQ, et al. Peroral endoscopic myotomy form advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study. Surg Endosc 2015; 29: 2841-2850. DOI: 10.1007/s00464-014-4013-9
28. Lv L, Liu J, Tan Y, et al. Peroral endoscopic full-thickness myotomy for the treatment of sigmoid-type achalasia: outcomes with a minimum follow-up of 12 months. Eur J Gastroenterol Hepatol 2016; 28:30-36. DOI: 10.1097/meg.0000000000000491
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Publication history

Received: 05/06/2016

Accepted: 20/07/2016

Online First: 21/09/2016

Published: 30/09/2016

Article revision time: 43 days

Article Online First time: 108 days

Article editing time: 117 days


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