How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective
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Datum
2020-09-22Autoren
Kahaleh, MichelTyberg, Amy
Suresh, Supriya
Lambroza, Arnon
Gaidhane, Monica
Zamarripa, Felipe
Martínez, Guadalupe Ma
Carames, Juan C
Moura, Eduardo T
Farias, Galileu F
Porfilio, Maria G
Nieto, Jose
Rey, Mario
Rodriguez Casas, Fernando
Mondragón Hernández, Oscar V
Vargas, Romulo Dario
Cañadas, Raúl
Hani, Albis
Muñoz, Guillermo
Castillo, Bismarck
Lukashok, Hannah P
Robles-Medranda, Carlos
de Moura, Eduardo G
Corporate Author(s)
Pontificia Universidad Javeriana. Facultad de Medicina. Departamento de Medicina Interna. Gastroenterología
Pontificia Universidad Javeriana. Facultad de Medicina. Hospital Universitario San Ignacio
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Artículo de revista
ISSN
2364-3722 / 2196-9736 (Electrónico)
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Background and study aims Both Heller myotomy (HM)
and per-oral endoscopic myotomy (POEM) are efficacious
therapies for achalasia. The efficacy and safety of POEM vs
HM in Latin America and specifically in patients with Chagas
disease is unknown.
Patients and methods Consecutive patients undergoing
either HM or POEM for achalasia were included from nine
Latin American centers in a prospective registry over 5
years. Technical success was defined as undergoing a successful myotomy. Clinical success was defined as achieving
an Eckardt score < 3. Data on demographics, procedure
info, Eckardt score, and adverse events (AEs) were collected. Student’s t test, Chi squared, and logistic regression
analyses were conducted.
Results One hundred thirty-three patients were included
(59 male; 44 %; mean age 47). POEM was performed in 69
patients, HM in 64 patients. A total of 35 patients had Chagas disease, 17 of 69 in the POEM group, 18 of 64 in the HM
group. Both groups had significant reduction in Eckardt
scores (P < 0.00001), but successful initial therapy was significantly higher in the POEM group compared to the HM
group (P = 0.01304). AEs were similar in both group (17 %
vs 14%) and consisted of pneumothorax (n = 3 vs 2), bleeding requiring transfusion (n = 3 vs 2), and mediastinitis (n = 3
vs 1). Hospital stay was longer in the HM group than in the
POEM group (P < 0.00001). In the Chagas subgroup, postprocedure Eckardt score in the POEM group was significantly reduced by 5.71 points (P < 0.00001) versus 1.56 points in
the HM group (P = 0.042793).
Conclusion Both HM and POEM are efficacious for achalasia, but POEM was associated with higher initial therapy
success and shorter hospital stay in Latin America. In Chagas patients with achalasia, POEM was significantly more effective than HM.
Räumliche Abdeckung
América LatinaVerknüpfen Sie mit der Ressource
https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-1223-1521Herkunft
Endoscopy International Open; Volumen 8 Número 10 , Páginas E1392 - E1397 (2020)
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