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Fawwaz BB, Zhang Y, Farooq A, Gorrepati VS, Forde JF, Canakis A, Kim R, Ma M, Benias P, Che S, Ujiki MB, Li AA, Hwang JH, Eke C, Kedia P, Yu A, Inayat I, Khalaf M, Othman M, Jawaid S, Hasan MK, Sharma N, Pomenti S, Sethi A, Draganov PV, Yang D. Peroral endoscopic myotomy for spastic esophageal dysmotility among opioid users: a multicenter propensity score matching study. Gastrointest Endosc 2024; 99:924-930. [PMID: 38184116 DOI: 10.1016/j.gie.2023.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/30/2023] [Accepted: 12/30/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND AIMS Opioid-induced esophageal dysfunction (OIED) often presents as spastic esophageal disorders (SEDs) and esophagogastric junction outflow obstruction (EGJOO). The aim of this study was to evaluate and compare clinical outcomes of peroral endoscopic myotomy (POEM) for SEDs and EGJOO among opioid users and nonusers. METHODS This propensity score (PS) matching study included consecutive opioid users and nonusers who underwent POEM for SEDs and EGJOO between January 2018 and September 2022. The following covariates were used for the PS calculation: age, sex, duration of symptoms, Eckardt score, type of motility disorder, and length of myotomy during POEM. Clinical response was defined as a post-POEM Eckardt score ≤3. RESULTS A total of 277 consecutive patients underwent POEM during the study period. PS matching resulted in the selection of 64 pairs of patients strictly matched 1:1 (n = 128) with no statistically significant differences in demographic, baseline, or procedural characteristics or in the parameters considered for the PS between the 2 groups. Clinical response to POEM was significantly lower among opioid users (51 of 64 [79.7%]) versus nonusers (60 of 64 [93.8%]) (P = .03) at a median follow-up of 18 months. Among opioid users, higher opioid dose (>60 morphine milligram equivalents per day) was associated with a higher likelihood of failure to respond to POEM (odds ratio, 4.59; 95% confidence interval, 1.31-3.98; P = .02). CONCLUSIONS Clinical response to POEM for SEDs and EGJOO is significantly lower among opioid users versus nonusers. There was a dose-relationship between opioids and response to POEM, with higher daily opioid usage associated with a higher likelihood of treatment failure.
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Affiliation(s)
| | - Yiyang Zhang
- Center for Collaborative Research, AdventHealth Research Institute, Orlando, Florida, USA
| | - Aimen Farooq
- Internal Medicine, AdventHealth Medical Group, Orlando, Florida, USA
| | - Venkata S Gorrepati
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Justin F Forde
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Raymond Kim
- Division of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Michael Ma
- Division of Gastroenterology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New York, New York, USA
| | - Petros Benias
- Division of Gastroenterology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New York, New York, USA
| | - Simon Che
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA
| | - Michael B Ujiki
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA
| | - Andrew A Li
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Chiemeziem Eke
- Gastroenterology, Methodist Dallas Medical Center, Dallas, Texas, USA
| | - Prashant Kedia
- Gastroenterology, Methodist Dallas Medical Center, Dallas, Texas, USA
| | - Abraham Yu
- Gastroenterology, Methodist Dallas Medical Center, Dallas, Texas, USA
| | - Irteza Inayat
- Gastroenterology and Hepatology, AdventHealth Medical Group, Orlando, Florida, USA
| | - Mai Khalaf
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Mohamed Othman
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Salmaan Jawaid
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Muhammad K Hasan
- Center for Interventional Endoscopy, AdventHealth Medical Group, Orlando, Florida, USA
| | - Neil Sharma
- Parkview Cancer Institute, Division of Interventional Oncology and Surgical Endoscopy, Parkview Health, Fort Wayne, Indiana, USA
| | - Sydney Pomenti
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth Medical Group, Orlando, Florida, USA.
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Yang D, Hasan MK, Bani Fawwaz B, Farooq A, Zhang Y, Khan HM, Brar TS, Singh S, Viana A, Singh G, Kadkhodayan K, Arain MA, Cosgrove N, Jain D, Inayat I, Singh C. Quantification of interstitial cells of Cajal and fibrosis during gastric per-oral endoscopic myotomy and its association with clinical outcomes. Endosc Int Open 2024; 12:E585-E592. [PMID: 38654965 PMCID: PMC11039041 DOI: 10.1055/a-2290-0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/04/2024] [Indexed: 04/26/2024] Open
Abstract
Background and study aims Alterations to interstitial cells of Cajal (ICC) and collagen fibrosis have been implicated in the pathogenesis of gastroparesis. We aimed to evaluate the feasibility and safety of pyloric muscle sampling during gastric peroral endoscopic myotomy (G-POEM) and the association between pyloric ICC density and degree of fibrosis with clinical outcomes. Patients and methods This was a single-center prospective study of gastroparetic patients who underwent G-POEM and intraprocedural pyloric muscle biopsies between January 2022 and April 2023. ICC count was estimated using CD117 stain and trichome for collagen fibrosis. Clinical response to G-POEM was defined as an improvement of ≥ 1 point on the Gastroparesis Cardinal Symptom Index. Results Fifty-six patients (median age 60 years, 71.4% women) underwent G-POEM (100% technical success; 71.4% clinical response). ICC depletion (< 10/high-power field) and fibrosis were encountered in 70.4% and 75% of the cases, respectively. There was no difference in mean ICC count between G-POEM responders vs. non-responders (7±3.6 vs. 7.7±3.3; P = 0.9). There was no association between ICC density or degree of fibrosis with the etiology of gastroparesis, duration of symptoms, gastric emptying rate, or pyloric impedance planimetry. Patients who did not respond to G-POEM had a significantly higher degree of moderate/severe fibrosis when compared with those who responded (81.3% vs. 25%; P = 0.0002). Conclusions Pyloric muscle biopsies during G-POEM was feasible and safe. ICC depletion and pyloric muscle fibrosis are common in gastroparetic patients. The degree of fibrosis may be related to pyloric dysfunction and clinical response to G-POEM. Additional studies are needed to confirm these results.
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Affiliation(s)
- Dennis Yang
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | | | | | - Aimen Farooq
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
- Internal Medicine, AdventHealth Central Florida, Orlando, United States
| | - Yiyang Zhang
- Statistics, AdventHealth Central Florida, Orlando, United States
| | - Hafiz M Khan
- Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, United States
| | - Tony S Brar
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Sanmeet Singh
- Gastroenterology, AdventHealth Central Florida, Orlando, United States
| | - Artur Viana
- Gastroenterology, AdventHealth Central Florida, Orlando, United States
| | - Gurdeep Singh
- Medicine, AdventHealth Central Florida, Orlando, United States
| | - Kambiz Kadkhodayan
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Mustafa A Arain
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Natalie Cosgrove
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Deepanshu Jain
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Irteza Inayat
- Gastroenterology, AdventHealth Central Florida, Orlando, United States
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