Details

Autor(en) / Beteiligte

• Chen, Yen-I, MD
• Inoue, Haruhiro, MD
• Ujiki, Michael, MD
• Draganov, Peter V., MD
• Colavita, Paul, MD
• Mion, Francois, MD
• Romanelli, John, MD
• Chiu, Philip, MD
• Balassone, Valerio, MD
• Patel, Lava, MD
• Abbas, Ali, MD
• Yang, Dennis, MD
• Dunst, Christy, MD
• Pioche, Mathieu, MD
• Roman, Sabine, MD
• Rivory, Jérôme, MD
• Ponchon, Thierry, MD
• Desilets, David, MD
• Maselli, Roberta, MD
• Onimaru, Manabu, MD
• Nakamura, Jun, MD
• Hata, Yoshitaka, MD
• Hajiyeva, Gulara, MD
• Ismail, Amr, MD
• Ngamruengphong, Saowanee, MD
• Bukhari, Majidah, MD
• Chavez, Yamile Haito, MD
• Kumbhari, Vivek, MD
• Repici, Alessandro, MD
• Khashab, Mouen A., MD

Titel

An international multicenter study evaluating the clinical efficacy and safety of per-oral endoscopic myotomy in octogenarians

Ist Teil von

• Gastrointestinal endoscopy, 2018-04, Vol.87 (4), p.956-961

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2018

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Background and Aims Per-oral endoscopic myotomy (POEM) for achalasia is particularly appealing in the elderly because it is minimally invasive. However, data in patients aged ≥80 years are scarce. The aim of this study was to assess the clinical outcome of POEM in octogenarians. Methods This was a multicenter retrospective study at 8 centers. Consecutive octogenarians with achalasia who underwent POEM between 2010 and 2016 were included. Rates of technical success (completion of myotomy), clinical response (Eckardt score ≤3), and adverse events (severity graded as per American Society for Gastrointestinal Endoscopy lexicon) were assessed. Results A total of 76 patients (47.4% female, mean age 84 years) underwent POEM for treatment of achalasia: type I, 17.1%, type II, 35.5%, type III, 17.1%, and unspecified, 30.3%. Overall, 41.1% were treatment-naïve, whereas others had previous botulinum toxin injections and/or pneumatic dilation. The mean (± standard deviation [SD]) age-adjusted Charlson Comorbidity Index was 6.2 ± 2.4, with the majority of patients having an American Society of Anesthesiologists Physical Status Classification System score of II/III. Technical success was 93.4%, with a median follow-up of 256 days. Fourteen adverse events occurred in 11 patients (14.5%) (3 inadvertent mucosotomies, 6 symptomatic capnoperitoneum/mediastinum, 2 esophageal leaks, 1 cardiac arrhythmia, and 2 other). The severities of these adverse events were 78.6% mild, 14.3% moderate, and 7.1% severe. Clinical success was achieved in 90.8% of patients, with a mean (± SD) Eckardt score reduction from 7.0 ± 2.3 to 0.8 ± 0.1 ( P  < .001) (median follow-up 256 days [interquartile range 66-547]). Conclusions Although the rate of technical success may be somewhat lower and the rate of adverse events slightly higher than previously reported, our data suggest that POEM in octogenarians is safe and effective, supporting its role as a primary modality for achalasia in this patient population.