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Palomba G, Basile R, Capuano M, Pesce M, Rurgo S, Sarnelli G, De Palma GD, Aprea G. Nasogastric tube after laparoscopic Heller-Dor surgery: Do you really need it? Curr Probl Surg 2024; 61:101457. [PMID: 38548426 DOI: 10.1016/j.cpsurg.2024.101457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/04/2024] [Accepted: 02/07/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Giuseppe Palomba
- Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
| | - Raffaele Basile
- Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marianna Capuano
- Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marcella Pesce
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Sara Rurgo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giovanni Domenico De Palma
- Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giovanni Aprea
- Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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de Moura ETH, Jukemura J, Ribeiro IB, Farias GFA, de Almeida Delgado AA, Coutinho LMA, de Moura DTH, Aissar Sallum RA, Nasi A, Sánchez-Luna SA, Sakai P, de Moura EGH. Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial. World J Gastroenterol 2022; 28:4875-4889. [PMID: 36156932 PMCID: PMC9476850 DOI: 10.3748/wjg.v28.i33.4875] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/07/2022] [Accepted: 08/05/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Achalasia is a rare benign esophageal motor disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES). The treatment of achalasia is not curative, but rather is aimed at reducing LES pressure. In patients who have failed noninvasive therapy, surgery should be considered. Myotomy with partial fundoplication has been considered the first-line treatment for non-advanced achalasia. Recently, peroral endoscopic myotomy (POEM), a technique that employs the principles of submucosal endoscopy to perform the equivalent of a surgical myotomy, has emerged as a promising minimally invasive technique for the management of this condition.
AIM To compare POEM and laparoscopic myotomy and partial fundoplication (LM-PF) regarding their efficacy and outcomes for the treatment of achalasia.
METHODS Forty treatment-naive adult patients who had been diagnosed with achalasia based on clinical and manometric criteria (dysphagia score ≥ II and Eckardt score > 3) were randomized to undergo either LM-PF or POEM. The outcome measures were anesthesia time, procedure time, symptom improvement, reflux esophagitis (as determined with the Gastroesophageal Reflux Disease Questionnaire), barium column height at 1 and 5 min (on a barium esophagogram), pressure at the LES, the occurrence of adverse events (AEs), length of stay (LOS), and quality of life (QoL).
RESULTS There were no statistically significant differences between the LM-PF and POEM groups regarding symptom improvement at 1, 6, and 12 mo of follow-up (P = 0.192, P = 0.242, and P = 0.242, respectively). However, the rates of reflux esophagitis at 1, 6, and 12 mo of follow-up were significantly higher in the POEM group (P = 0.014, P < 0.001, and P = 0.002, respectively). There were also no statistical differences regarding the manometry values, the occurrence of AEs, or LOS. Anesthesia time and procedure time were significantly shorter in the POEM group than in the LM-PF group (185.00 ± 56.89 and 95.70 ± 30.47 min vs 296.75 ± 56.13 and 218.75 ± 50.88 min, respectively; P = 0.001 for both). In the POEM group, there were improvements in all domains of the QoL questionnaire, whereas there were improvements in only three domains in the LM-PF group.
CONCLUSION POEM and LM-PF appear to be equally effective in controlling the symptoms of achalasia, shortening LOS, and minimizing AEs. Nevertheless, POEM has the advantage of improving all domains of QoL, and shortening anesthesia and procedure times but with a significantly higher rate of gastroesophageal reflux.
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Affiliation(s)
- Eduardo Turiani Hourneaux de Moura
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Sao Paulo 05403-010, Brazil
| | - José Jukemura
- Division of Esophageal Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, Sao Paulo 05403-010, Brazil
| | - Igor Braga Ribeiro
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Sao Paulo 05403-010, Brazil
| | - Galileu Ferreira Ayala Farias
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Hospital das Clínicas, University of São Paulo School of Medicine, Sao Paulo 05403-010, Brazil
| | - Aureo Augusto de Almeida Delgado
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Hospital das Clínicas, University of São Paulo School of Medicine, Sao Paulo 05403-010, Brazil
| | - Lara Meireles Azeredo Coutinho
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Hospital das Clínicas, University of São Paulo School of Medicine, Sao Paulo 05403-010, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Hospital das Clínicas, University of São Paulo School of Medicine, Sao Paulo 05403-010, Brazil
| | - Rubens Antonio Aissar Sallum
- Division of Esophageal Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, Sao Paulo 05403-010, Brazil
| | - Ary Nasi
- Division of Esophageal Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, Sao Paulo 05403-010, Brazil
| | - Sergio A Sánchez-Luna
- Department of Internal Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology and Hepatology, Birmingham, AL 35233, United States
| | - Paulo Sakai
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Sao Paulo 05403-010, Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Sao Paulo 05403-010, Brazil
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Costa LCDAS, Braga JGR, Tercioti Junior V, Coelho Neto JDES, Ferrer JAP, Lopes LR, Andreollo NA. Surgical treatment of relapsed megaesophagus. ACTA ACUST UNITED AC 2020; 47:e20202444. [PMID: 32520130 DOI: 10.1590/0100-6991e-20202444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/29/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE to analyze the surgical treatment of patients with recurrent megaesophagus followed at the esophageal-stomach-duodenal outpatient clinic of the Hospital de Clínicas - UNICAMP. METHODS a retrospective study, from 2011 to 2017, with 26 patients with Chagas or idiopathic megaesophagus, surgically treated, and who recurred with dysphagia. Clinical, endoscopic and radiographic aspects were assessed and correlated with the performed surgical procedures. RESULTS 50% had dysphagia for liquids, 69% regurgitation, 65.3% heartburn, 69.2% weight loss and 69.2% had Chagas disease. In addition, 38.4% had megaesophagus stage 1 and 2 and 61.5% stage 3 and 4. Regarding the reoperations, 53% of them underwent Heller-Pinotti surgery by laparoscopy, Serra-Dória in 30.7% and esophageal mucosectomy in 7.9%. In 72% of the reoperations there were no postoperative complications, and 80% of the patients had a good outcome, with reduction or elimination of dysphagia. Among the reoperated patients undergoing the laparoscopic Heller-Pinotti technique, three reported little improvement of dysphagia in the postoperative period and among those who underwent Serra-Dória surgery, 100% had no dysphagia. It was observed that, when the time between the first procedure and the reoperation was longer, the better the surgical result was, with statistical significant decreased dysphagia (p=0.0013, p<0.05). CONCLUSIONS there was a preference to perform laparoscopic re-miotomy and, as a second option, Serra-Dória surgery, for patients with recurrent megaesophagus. Esophagectomy or esophageal mucosectomy were reserved for more severe patients.
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Affiliation(s)
| | | | - Valdir Tercioti Junior
- - Faculty of Medical Sciences / UNICAMP, Department of Surgery - Campinas - São Paulo - Brazil
| | | | | | - Luiz Roberto Lopes
- - Faculty of Medical Sciences / UNICAMP, Department of Surgery - Campinas - São Paulo - Brazil
| | - Nelson Adami Andreollo
- - Faculty of Medical Sciences / UNICAMP, Department of Surgery - Campinas - São Paulo - Brazil
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Miller DR, Averbukh LD, Kwon SY, Farrell J, Bhargava S, Horrigan J, Tadros M. Phosphodiesterase inhibitors are viable options for treating esophageal motility disorders: A case report and literature review. J Dig Dis 2019; 20:495-499. [PMID: 31347278 DOI: 10.1111/1751-2980.12802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 12/11/2022]
Affiliation(s)
- David R Miller
- Department of Medicine, Division of Gastroenterology-Hepatology, Albany Medical Center, Albany, New York, USA
| | - Leon D Averbukh
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Soo Yeon Kwon
- Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - Jessica Farrell
- Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - Siddharth Bhargava
- Department of Medicine, Division of Gastroenterology-Hepatology, Albany Medical Center, Albany, New York, USA
| | - Jamie Horrigan
- Department of Medicine, Division of Gastroenterology-Hepatology, Albany Medical Center, Albany, New York, USA
| | - Micheal Tadros
- Department of Medicine, Division of Gastroenterology-Hepatology, Albany Medical Center, Albany, New York, USA
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Laurino-Neto RM, Herbella F, Schlottmann F, Patti M. EVALUATION OF ESOPHAGEAL ACHALASIA: FROM SYMPTOMS TO THE CHICAGO CLASSIFICATION. ACTA ACUST UNITED AC 2018; 31:e1376. [PMID: 29972404 PMCID: PMC6044194 DOI: 10.1590/0102-672020180001e1376] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/27/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The diagnosis of achalasia may be suggested by clinical features but a complete work-up is required not only to confirm the diagnosis but also to grade the disease by severity or clinical subtype. OBJECTIVE To review the current evaluation of esophageal achalasia and its correct comprehension. METHOD The literature review was based on papers published on Medline/Pubmed, SciELO and Lilacs, crossing the following headings: "esophageal achalasia"; "deglutition disorders"; "diagnostic techniques", "digestive system"; "endoscopy, digestive system"; "manometry". RESULTS The diagnosis of achalasia is suggested by clinical features but is not sufficient to distinguish this from other esophageal disease. It must be confirmed by further diagnostic tests, such as esophagogastroduodenoscopy, barium swallow and manometry. Recent advances in diagnostic methods, including high resolution manometry might even help predicting outcome or selected more appropriate procedures to treat the disease. CONCLUSION A detailed and systematic study of achalasia patients allows not only a correct diagnosis but also contributes to therapeutic decision making and prognosis.
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Affiliation(s)
| | - Fernando Herbella
- Departamento de Cirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP
| | - Francisco Schlottmann
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Marco Patti
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
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Schlottmann F, Herbella FA, Patti MG. Understanding the Chicago Classification: From Tracings to Patients. J Neurogastroenterol Motil 2017; 23:487-494. [PMID: 28866876 PMCID: PMC5628980 DOI: 10.5056/jnm17026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/26/2017] [Accepted: 06/09/2017] [Indexed: 01/29/2023] Open
Abstract
Current parameters of the Chicago classification include assessment of the esophageal body (contraction vigour and peristalsis), lower esophageal sphincter relaxation pressure, and intra-bolus pressure pattern. Esophageal disorders include achalasia, esophagogastric junction outflow obstruction, major disorders of peristalsis, and minor disorders of peristalsis. Sub-classification of achalasia in types I, II, and III seems to be useful to predict outcomes and choose the optimal treatment approach. The real clinical significance of other new parameters and disorders is still under investigation.
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Affiliation(s)
- Francisco Schlottmann
- Department of Surgery and Center for Esophageal Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Fernando A Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Marco G Patti
- Department of Surgery and Center for Esophageal Diseases, University of North Carolina, Chapel Hill, NC, USA
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