Selective inner muscle layer myotomy is associated with lower pain and same clinical efficacy that full-thickness myotomy in patients treated by POEM for achalasia: A multicenter retrospective comparative analysis of 158 patients - 10/07/24
, Blandine Vauquelin b, Marie-Christine Picot c, Romain Altwegg a, Anne Bozon a, Flora Charpy a, Ludovic Caillo d, Arthur Berger b, Frank Zerbib b, Antoine Debourdeau a, dHighlights |
• | POEM for achalasia: Selective myotomy targeting inner circular layer equals full thickness in efficacy. |
• | Full thickness myotomy was associated with longer hospital stays and more pain relief use. |
• | No significant difference in reflux rates between selective and full thickness myotomy. |
• | Selective circular myotomy should be preferred over full thickness in POEM for achalasia. |
Abstract |
Introduction |
The aim of this study was to compare the impact of the depth of myotomy (selective inner layer myotomy (SIM) vs. full-thickness myotomy (FTM)) on the outcome of patients treated with POEM for achalasia.
Methods |
This was a retrospective, observational, conducted in two tertiary centers between October 2018 and September 2022. Patients were divided into two groups: SIM and FTM. The primary endpoint was clinical efficacy at 6 months, while secondary endpoints were postoperative criteria (such as pain, length of hospital stay, complications) and occurrence of gastroesophageal reflux disease (GERD) (esophagitis at 6 months, heartburn, and pH-metry).
Results |
158 patients were included in the study (33 in the FTM group and 125 in the SIM group). The success rates at 6 and 12 months were similar in both groups, with 84 % and 70 % in the SIM group versus 90 % and 80 % in the FTM group, respectively (p = 0.57 and p = 0.74). However, more opioid analgesics were consumed in the FTM group compared to the SIM group (41% vs 21 %, p < 0.01). The length of hospitalization was longer in the FTM group than in the SIM group (2.17 ± 2.62 vs 2.94 ± 2.33, p < 0.001). The rate of esophagitis at 6 months was comparable (16 % in the SIM group vs 12 % in the FTM group, p = 0.73). There was no significant difference in terms of heartburn at 6 or 12 months between the SIM and FTM groups (18.5% vs 3.8 %, p = 0.07 and 27% vs 12.5 %, p = 0.35, respectively).
Conclusion |
There was no significant difference in terms of clinical efficacy and GERD occurrence between FTM and SIM. However, full-thickness myotomy was associated with more postoperative pain and a longer length of hospital stay. Therefore, selective internal myotomy should be preferred over full-thickness myotomy.
Le texte complet de cet article est disponible en PDF.Key words : Achalasia, Poem, Selective myotomy, Oesophagus
Plan
Vol 48 - N° 7
Article 102401- août 2024 Retour au numéro
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