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
•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 circul...
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| Veröffentlicht in: | Clinics and research in hepatology and gastroenterology 2024-08, Vol.48 (7), p.102401, Article 102401 |
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| container_title | Clinics and research in hepatology and gastroenterology |
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| creator | Sanavio, Mathilde Vauquelin, Blandine Picot, Marie-Christine Altwegg, Romain Bozon, Anne Charpy, Flora Caillo, Ludovic Berger, Arthur Zerbib, Frank Debourdeau, Antoine |
| description | •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.
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.
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).
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).
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. |
| doi_str_mv | 10.1016/j.clinre.2024.102401 |
| format | Article |
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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.
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).
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).
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.</description><identifier>ISSN: 2210-7401</identifier><identifier>ISSN: 2210-741X</identifier><identifier>EISSN: 2210-741X</identifier><identifier>DOI: 10.1016/j.clinre.2024.102401</identifier><identifier>PMID: 38897558</identifier><language>eng</language><publisher>France: Elsevier Masson SAS</publisher><subject>Achalasia ; Adult ; Aged ; Esophageal Achalasia - surgery ; Female ; Gastroesophageal Reflux - surgery ; Humans ; Length of Stay - statistics & numerical data ; Male ; Middle Aged ; Myotomy - methods ; Oesophagus ; Pain, Postoperative - etiology ; Retrospective Studies ; Selective myotomy ; Treatment Outcome</subject><ispartof>Clinics and research in hepatology and gastroenterology, 2024-08, Vol.48 (7), p.102401, Article 102401</ispartof><rights>2024 The Author(s)</rights><rights>Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c287t-fce6f1a6f9a85a79e5bffa7c9fef6909da25871e2745e0e986b944b571152d643</cites><orcidid>0000-0003-3785-6948</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S2210740124001220$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38897558$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sanavio, Mathilde</creatorcontrib><creatorcontrib>Vauquelin, Blandine</creatorcontrib><creatorcontrib>Picot, Marie-Christine</creatorcontrib><creatorcontrib>Altwegg, Romain</creatorcontrib><creatorcontrib>Bozon, Anne</creatorcontrib><creatorcontrib>Charpy, Flora</creatorcontrib><creatorcontrib>Caillo, Ludovic</creatorcontrib><creatorcontrib>Berger, Arthur</creatorcontrib><creatorcontrib>Zerbib, Frank</creatorcontrib><creatorcontrib>Debourdeau, Antoine</creatorcontrib><title>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</title><title>Clinics and research in hepatology and gastroenterology</title><addtitle>Clin Res Hepatol Gastroenterol</addtitle><description>•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.
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.
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).
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).
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.</description><subject>Achalasia</subject><subject>Adult</subject><subject>Aged</subject><subject>Esophageal Achalasia - surgery</subject><subject>Female</subject><subject>Gastroesophageal Reflux - surgery</subject><subject>Humans</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myotomy - methods</subject><subject>Oesophagus</subject><subject>Pain, Postoperative - etiology</subject><subject>Retrospective Studies</subject><subject>Selective myotomy</subject><subject>Treatment Outcome</subject><issn>2210-7401</issn><issn>2210-741X</issn><issn>2210-741X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UU1v1DAQjRCIVqX_ACEfuWSxvXY-OCBVVfmQiooESNysiTPWenHiYDut8oP5H3ibZbnhy8xYb968mVcULxndMMqqN_uNdnYMuOGUi_zFBWVPinPOGS1rwX48PeWUnRWXMe5pfkLSpmbPi7Nt07S1lM158fsrOtTJ3iOx44iBDHPUDomD5VAsPvlhITYSiNFrCwl78mDTjjj_kAET2JHA2JMIA5KDJqvBETQmR72QtINEzOxcmXZW_xwxxn-kY25PFscUSQr4SN0t5MvdzWdifCCgd-AgWnhLrrIsl6zO2Dw0YAo-TkfZ2g8TBHjMYQS3xKzWG8Jkc-J_UTwz4CJeHuNF8f39zbfrj-Xt3YdP11e3peZNnUqjsTIMKtNCI6FuUXbGQK1bg6ZqadsDl_mAyGshkWLbVF0rRCdrxiTvK7G9KF6vvFPwv2aMSQ02anQORvRzVFta04aLqmUZKlaozrvEgEZNwQ4QFsWoOnis9mr1WB08VqvHue3VccLcDdifmv46mgHvVgDmPe8tBhV1voHG3oZ8MdV7-_8JfwBFFL_m</recordid><startdate>202408</startdate><enddate>202408</enddate><creator>Sanavio, Mathilde</creator><creator>Vauquelin, Blandine</creator><creator>Picot, Marie-Christine</creator><creator>Altwegg, Romain</creator><creator>Bozon, Anne</creator><creator>Charpy, Flora</creator><creator>Caillo, Ludovic</creator><creator>Berger, Arthur</creator><creator>Zerbib, Frank</creator><creator>Debourdeau, Antoine</creator><general>Elsevier Masson SAS</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3785-6948</orcidid></search><sort><creationdate>202408</creationdate><title>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</title><author>Sanavio, Mathilde ; Vauquelin, Blandine ; Picot, Marie-Christine ; Altwegg, Romain ; Bozon, Anne ; Charpy, Flora ; Caillo, Ludovic ; Berger, Arthur ; Zerbib, Frank ; Debourdeau, Antoine</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c287t-fce6f1a6f9a85a79e5bffa7c9fef6909da25871e2745e0e986b944b571152d643</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Achalasia</topic><topic>Adult</topic><topic>Aged</topic><topic>Esophageal Achalasia - surgery</topic><topic>Female</topic><topic>Gastroesophageal Reflux - surgery</topic><topic>Humans</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myotomy - methods</topic><topic>Oesophagus</topic><topic>Pain, Postoperative - etiology</topic><topic>Retrospective Studies</topic><topic>Selective myotomy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sanavio, Mathilde</creatorcontrib><creatorcontrib>Vauquelin, Blandine</creatorcontrib><creatorcontrib>Picot, Marie-Christine</creatorcontrib><creatorcontrib>Altwegg, Romain</creatorcontrib><creatorcontrib>Bozon, Anne</creatorcontrib><creatorcontrib>Charpy, Flora</creatorcontrib><creatorcontrib>Caillo, Ludovic</creatorcontrib><creatorcontrib>Berger, Arthur</creatorcontrib><creatorcontrib>Zerbib, Frank</creatorcontrib><creatorcontrib>Debourdeau, Antoine</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinics and research in hepatology and gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sanavio, Mathilde</au><au>Vauquelin, Blandine</au><au>Picot, Marie-Christine</au><au>Altwegg, Romain</au><au>Bozon, Anne</au><au>Charpy, Flora</au><au>Caillo, Ludovic</au><au>Berger, Arthur</au><au>Zerbib, Frank</au><au>Debourdeau, Antoine</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Clinics and research in hepatology and gastroenterology</jtitle><addtitle>Clin Res Hepatol Gastroenterol</addtitle><date>2024-08</date><risdate>2024</risdate><volume>48</volume><issue>7</issue><spage>102401</spage><pages>102401-</pages><artnum>102401</artnum><issn>2210-7401</issn><issn>2210-741X</issn><eissn>2210-741X</eissn><abstract>•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.
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.
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).
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).
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.</abstract><cop>France</cop><pub>Elsevier Masson SAS</pub><pmid>38897558</pmid><doi>10.1016/j.clinre.2024.102401</doi><orcidid>https://orcid.org/0000-0003-3785-6948</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinics and research in hepatology and gastroenterology, 2024-08, Vol.48 (7), p.102401, Article 102401 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Achalasia Adult Aged Esophageal Achalasia - surgery Female Gastroesophageal Reflux - surgery Humans Length of Stay - statistics & numerical data Male Middle Aged Myotomy - methods Oesophagus Pain, Postoperative - etiology Retrospective Studies Selective myotomy Treatment Outcome |
| title | 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 |
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