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Endoscopy 2024; 56(06): 431-436
DOI: 10.1055/a-2239-7371
Innovations and brief communications

When less is more: lower esophageal sphincter-preserving peroral endoscopic myotomy is effective for non-achalasia esophageal motility disorders

Varan Perananthan
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
Sunil Gupta 
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
Anthony Whitfield
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
Ana Craciun
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
3   Gastroenterology and Hepatology, Centro Hospitalar Universitario de Lisboa Norte, Lisbon, Portugal
,
Oliver Cronin
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
Timothy O'Sullivan
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
Karen Byth
4   Western Sydney Local Health District Research and Education Network, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
5   NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
,
Mayenaaz Sidhu
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
,
Luke F. Hourigan
6   Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia (Ringgold ID: RIN1966)
7   Gallipoli Medical Research Institute, School of Medicine, The University of Queensland Greenslopes Clinical Unit, Brisbane, Australia (Ringgold ID: RIN242074)
,
Spiro Raftopoulos
8   Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Australia (Ringgold ID: RIN5728)
9   Faculty of Medicine, The University of Western Australia, Perth, Australia (Ringgold ID: RIN2720)
10   Faculty of Medicine, Curtin University, Perth, Australia (Ringgold ID: RIN1649)
,
Nicholas G. Burgess 
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
Michael J. Bourke
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
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Corrected by:

Correction: When less is more: lower esophageal sphincter-preserving peroral endoscopic myotomy is effective for non-achalasia esophageal motility disordersEndoscopy 2024; 56(06): C4-C4
DOI: 10.1055/a-2281-2969

Abstract

Background Non-achalasia esophageal motility disorders (NAEMDs), encompassing distal esophageal spasm (DES) and hypercontractile esophagus (HCE), are rare conditions. Peroral endoscopic myotomy (POEM) is a promising treatment option. In NAEMDs, unlike with achalasia, the lower esophageal sphincter (LES) functions normally, suggesting the potential of LES preservation during POEM.

Methods This retrospective two-center observational study focused on patients undergoing LES-preserving POEM (LES-POEM) for NAEMD. Eckardt scores were assessed pre-POEM and at 6, 12, and 24 months post-POEM, with follow-up endoscopy at 6 months to evaluate for reflux esophagitis. Clinical success, defined as an Eckardt score ≤3, served as the primary outcome.

Results 227 patients were recruited over 84 months until May 2021. Of these, 16 underwent LES-POEM for an NAEMD (9 with HCE and 7 with DES). The median pre-POEM Eckardt score was 6.0 (interquartile range [IQR] 5.0–7.0), which decreased to 1.0 (IQR 0.0–1.8; P<0.001) 6 months post-POEM. This was sustained at 24 months, with an Eckardt score of 1.0 (IQR 0.0–1.8; P<0.001). Two patients (12.5%) developed Los Angeles grade A or B esophagitis.

Conclusions LES-POEM for NAEMD demonstrates favorable clinical outcomes, with infrequent esophagitis and reintervention for LES dysfunction rarely required.



Publication History

Received: 19 June 2023

Accepted after revision: 06 January 2024

Accepted Manuscript online:
06 January 2024

Article published online:
08 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Letter to this article:

Assessing lower esophageal sphincter integrity during peroral endoscopic myotomy: navigating the challenges of preservation versus divisionEndoscopy 2024; 56(09): 719-719
DOI: 10.1055/a-2283-5481

 

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