Endoscopic esophagoplasty for megaesophagus with sump stasis in end-stage achalasia.
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ABSTRACT:
SUBMITTER: Bazerbachi F
PROVIDER: S-EPMC6095939 | biostudies-literature | 2017 Nov
REPOSITORIES: biostudies-literature
Publications
Endoscopic esophagoplasty for megaesophagus with sump stasis in end-stage achalasia.
Bazerbachi Fateh F Blackmon Shanda H SH Ravi Karthik K Wong Kee Song Louis M LM
VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 20170928 11
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| S-EPMC5990890 | biostudies-literature
Project description:Peroral endoscopic myotomy (POEM) has been recently considered as the first treatment option for achalasia. The standard POEM procedures are often successful in most patients, but sometimes technical challenges are encountered. We report a new technique that is divided between two tunneling sites in the esophagus for sigmoid-type achalasia. A 40-year-old male patient with dysphagia for 10 years was diagnosed with a sigmoid-shaped esophagus at our hospital. We devised a two-stage myotomy technique to treat sigmoidtype achalasia. The myotomy was first performed in the upper part of the greater flexion area and then in the lower part of the flexion. We termed this method "two-stage POEM", which was successfully performed without any complications. This new POEM method can also be used to improve symptoms in patients with achalasia who have a structural deformity that may result in a high change of treatment failure.
| S-EPMC7137558 | biostudies-literature
Project description:Background/aimsSigmoid esophagus and/or megaesophagus are considered as an advanced stage in the natural history of achalasia cardia. The role of peroral endoscopic myotomy (POEM) in these subset of patients is emerging. We performed a systematic review and metanalysis to study the efficacy of POEM in advanced achalasia cardia with sigmoid and megaesophagus.MethodsA literature search in PubMed and Embase was done from inception till August 3, 2021 to look for studies reporting exclusively on the role of POEM in advanced achalasia cardia with sigmoid and/or megaesophagus. The random effect method with inverse variance approach was used for the computation of pooled prevalence. For 2 groups' analysis of continuous outcome standardized mean difference was used as the summary measure.ResultsEleven studies with 428 patients were included for analysis. The pooled technical and clinical success was 98.27% (95% CI, 96.19-99.22; I2 = 0%) and 89.38% (95% CI, 84.49-92.86; I2 = 26%) and on subgroup analysis into sigmoid and megaesophagus it was (98.06% [95% CI, 95.41-99.19; I2 = 0%], 98.47% [95% CI, 92.72-99.69; I2 = 0%] and 87.92% [95% CI, 80.68-92.70; I2 = 37%], 88.36% [95% CI, 62.62-97.17; I2 = 77%]) respectively. The clinical success at < 1 year and 1-3 year follow-up was 89.37% (95% CI, 82.82-93.61; I2 = 0%) and 88.66% (95% CI, 81.65-91.22; I2 = 46%) respectively. There was a significant reduction in the post-POEM scores with standardized mean difference for Eckardt score (4.81), for integrated relaxation pressure at 4 seconds (1.93), and for lower esophageal sphincter pressure (2.06).ConclusionsPOEM is an effective modality of treatment even in the subset of patients of advanced achalasia cardia with sigmoid and megaesophagus.
| S-EPMC8748859 | biostudies-literature
Project description:IntroductionAchalasia is a rare esophageal motility disorder causing dysphagia and weight loss. Severe cases may present with a significantly dilated and sigmoid-shaped esophagus (sigmoid achalasia). Traditionally, esophagectomy was used for such cases. However, laparoscopic Heller myotomy (LHM) is emerging as a less invasive alternative with comparable outcomes.Case presentationWe present a 45-year-old male with a seven-year history of dysphagia, regurgitation, chest pain, and recent weight loss. Barium esophagogram, high-resolution esophageal manometry, and upper endoscopy confirmed severe achalasia with a sigmoid esophagus (Type I according to Chicago classification). Esophagectomy was considered, but due to the patient's age and the lack of prior treatment attempts, LHM with Dor's fundoplication was performed successfully. At 24-month follow-up, the patient reported significant symptom improvement and weight gain.Clinical discussionWhile esophagectomy was historically used for severe achalasia, LHM is increasingly being employed due to its minimally invasive nature and favorable outcomes. This case highlights the potential benefits of LHM in carefully selected patients with severe achalasia, even those with sigmoid esophagus. However, it's important to acknowledge that LHM may not be suitable for all end-stage cases, and esophagectomy might be necessary in some situations. CONCLUSIóN: Laparoscopic Heller myotomy with Dor's fundoplication is a promising treatment option for end-stage of achalasia, offering faster recovery and improved quality of life. However, further long-term studies are needed to confirm its long-term effectiveness.
| S-EPMC11570774 | biostudies-literature
Project description:Introduction and importanceEnd-stage achalasia is a rare disease, consisting of a functional impairment of the esophagus which becomes dilated with a sigmoid shape. While esophagectomy was considered for a long time as the principal surgical procedure in end-stage achalasia, recent literature results demonstrate that laparoscopic Heller Dor (LHD) could be an advocated alternative with acceptable functional results.Case presentationWe present the case of an eighty-three-year-old male, an elderly patient, who had been complaining for one year of dysphagia and general status loss. Endoscopy, manometry then a barium X-ray confirmed end-stage achalasia. The patient had LHD with an improvement of symptomatology post-operatively.Clinical discussionAchalasia is a rare disease affecting oesophagal motility. The diagnosis is suggested clinically and confirmed by a wide range of tests notably esophagogastroduodenoscopy, barium swallow and manometry. The diagnosis of achalasia is classically made by demonstrating impaired relaxation of the lower oesophagal sphincter and absent peristalsis in the oesophagal manometry. Esophagogastroduodenoscopy is made mainly to eliminate the diagnosis of oesophagal cancer. Barium swallow, however, is done to appreciate the impact of achalasia on the rest of the esophagus.ConclusionOur case highlights the satisfying results after an LHD which is an alternative to esophagectomy especially in elderlies with high risk.
| S-EPMC10510054 | biostudies-literature
Project description:IntroductionAchalasia with megaesophagus is a pathology characterized by widespread and irregular dilation of the esophageal lumen. In most cases, this dilation is caused by contraction and subsequent failed relaxation of the lower esophageal sphincter (LES). It may be associated with a partial or complete slowing of the esophageal peristalsis.Case overviewWe present the case of a 58-year-old woman who developed dysphagia, regurgitation, and substantial weight loss (11 kg) over a span of 1 year. Symptomatic achalasia with megaesophagus was diagnosed following chest and abdominal computed tomography (CT) with contrast and transit RX with gastrografin and esophageal manometry. The patient refuse all minimally endoscopic treatments and opted straightly for the treatment with esophagectomy sec. Ivor-Lewis. At the 6-month follow-up, the patient appeared in excellent general clinical condition and oral gastrografin radiography (OGR) showed good channeling.DiscussionPatients require medical attention when presenting with achalasia that has eroded the esophageal wall enough to form a megaesophagus. Early and minimally invasive treatments (i.e., medical therapy, endoscopic dilation, and myotomy) are insufficient at this stage, and thus esophageal surgery is required. Among the most common surgical approaches, we must mention esophagectomy sec. McKeown and esophagectomy with interposition of a colic loop sec. Wilkins; however, based on our experience, esophagectomy sec. Ivor-Lewis with intrathoracic anastomosis leads to excellent results and can therefore be considered a valid alternative for treating complex cases.ConclusionsSubtotal esophagectomy sec. Ivor-Lewis with intrathoracic anastomosis is effective in treating achalasia with megaesophagus.
| S-EPMC9142608 | biostudies-literature
Project description:Achalasia is a neurodegenerative motility disorder caused by enteric neuron damage in the lower esophageal sphincter. Peroral endoscopic myotomy (POEM) is a standard treatment method for achalasia. Previous treatment modalities may affect the outcome of POEM as they cause submucosal fibrosis. We report a new technique called "hybrid POEM" for the treatment of patients with achalasia who had been previously treated with pneumatic balloon dilatation. We performed two techniques of POEM simultaneously, the standard POEM for the upper part of the submucosal tunnel and open POEM for the stenotic part of the esophagogastric junction. We dissected the mucosa and submucosa, and performed myotomy simultaneously. We overcame submucosal fibrosis of the esophagogastric junction, which was caused by the previous hybrid POEM treatment. The risks of mucosal incision and technical challenge of submucosal tunneling for the fibrotic area may be reduced by hybrid POEM.
| S-EPMC7939763 | biostudies-literature
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| S-EPMC7434591 | biostudies-literature
Project description:The recent development of per oral endoscopic myotomy (POEM) has been a game changer in the management of patients with achalasia. However, approximately 1 in 10 patients will not experience clinical success. The aim of this mini-review is to describe the current state of knowledge about the risk factors associated with POEM failure for the treatment of achalasia. Suspected risk factors are detailed into pre-, intra-, and post-procedural factors and put into perspective. Pre-procedural factors have been described, such as pre-treatment Eckardt score, previous treatments for achalasia, sigmoid type esophagus, significant esophageal dilatation, non-type II achalasia, young age and long duration of symptoms. An intra-procedural factor, mucosal injury during POEM, has also been associated with POEM failure. The occurrence of post-POEM GERD was identified as a controversial post-procedural factor associated with failure. The presumed mechanisms of POEM failure are incomplete myotomy or ineffective LES disruption, as confirmed by high-resolution manometry. However, when manometry confirms a significant decrease in LES pressure, it is likely that either impaired peristalsis or a morphologic abnormality such as extreme esophageal dilatation or severe tortuosity, which are not treated by POEM, should be suspected. Notably, a recently described adverse effect of POEM is the formation of a pseudo-diverticulum at the site of the myotomy (blown out myotomy). We finally stress the importance of performing a complete workup in case of POEM failure as different mechanisms of POEM failure should lead to different management.
| S-EPMC9773253 | biostudies-literature