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Functional restoration of the esophagus after peroral endoscopic myotomy for achalasia

 Cheal Wung Huh  ;  Young Hoon Youn  ;  Hyunsoo Chung  ;  Yong Chan Lee  ;  Hyojin Park 
 PLOS ONE, Vol.12(5) : e0178414, 2017 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Esophageal Achalasia/pathology ; Esophageal Achalasia/physiopathology ; Esophageal Achalasia/surgery ; Esophagoscopy ; Esophagus/pathology ; Esophagus/physiopathology ; Esophagus/surgery ; Female ; Humans ; Male ; Manometry ; Middle Aged ; Muscle, Smooth/pathology ; Muscle, Smooth/physiopathology ; Muscle, Smooth/surgery ; Natural Orifice Endoscopic Surgery ; Organ Size ; Peristalsis ; Prospective Studies ; Recovery of Function ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome ; Young Adult
Purpose Peroral endoscopic myotomy (POEM) is a new efficacious treatment option for achalasia. We propose to define “esophageal remodeling” as the functional restoration of the esophagus that involves decreased lower esophageal sphincter (LES) pressure, recovery of esophageal body peristalsis, and reduction of luminal diameter. The aim of this study was to investigate “esophageal remodeling” after POEM for achalasia. Materials and methods We analyzed data from a prospectively collected database of POEM subjects, which included preoperative and 2-month postoperative Eckardt symptom scores, and results from esophageal high resolution manometry (HRM) and barium esophagogram (BE). We recruited 23 patients (13 male; mean age: 53.9 years) whose preoperative and postoperative HRM and BE results were available, from among 30 patients with achalasia who underwent POEM at two institutions between July 2013 and December 2015. Results All patients achieved clinical treatment success (Eckardt score≤3). Partial recovery of esophageal body peristalsis was noted in 1/5 patients with type I (20%), 6/11 with type II (54.5%), and 7/7 with type III (100%) achalasia after POEM. Pan-esophageal pressurization disappeared after POEM in 10/11 type II achalasia patients. The average diameter of the esophageal body after POEM was significantly decreased in all types of achalasia. Conclusion POEM provided excellent clinical symptomatic relief and esophageal remodeling in terms of restoration of peristalsis and reduction in diameter of the esophageal body, especially in patients with type III achalasia.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Hyo Jin(박효진) ORCID logo https://orcid.org/0000-0003-4814-8330
Youn, Young Hoon(윤영훈) ORCID logo https://orcid.org/0000-0002-0071-229X
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Chung, Hyun Soo(정현수)
Huh, Cheal Wung(허철웅)
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