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Morphologic Restoration After Peroral Endoscopic Myotomy in Sigmoid-type Achalasia

Authors
 Hong Jin Yoon  ;  Jeung Eun Lee  ;  Da Hyun Jung  ;  Jun Chul Park  ;  Young Hoon Youn  ;  Hyojin Park 
Citation
 JOURNAL OF NEUROGASTROENTEROLOGY AND MOTILITY, Vol.26(1) : 67-73, 2020-01 
Journal Title
JOURNAL OF NEUROGASTROENTEROLOGY AND MOTILITY
ISSN
 2093-0879 
Issue Date
2020-01
Keywords
Esophageal achalasia ; Myotomy ; Peroral endoscopic myotomy ; Sigmoid-type achalasia
Abstract
Background/aims: Achalasia is a chronic, progressive motility disorder of the esophagus. The sigmoid-type achalasia is an advanced stage of achalasia characterized by severe dilatation and tortuous angulation of the esophageal body. Peroral endoscopic myotomy (POEM) has been reported to provide excellent clinical outcomes for achalasia, including the sigmoid type, but the restoration of esophageal morphology and function remain poorly described. The aim of our study is to investigate esophageal restoration after POEM for sigmoid-type achalasia.

Methods: From 98 patients with achalasia who underwent POEM in the Yonsei University Health System from 2013 to 2018, we recruited 13 patients with sigmoid-type achalasia (7 male; mean age 53.3 years) and assessed morphological and manometric changes in the esophagus.

Results: Clinical success (Eckardt score < 3) was achieved in all cases. After POEM, the average angle of esophageal tortuosity became more obtuse (91.5° vs 114.6°, P = 0.046), esophageal body diameter decreased (67.6 vs 49.8 mm, P = 0.002), and esophagogastric junction opening widened (6.4 vs 9.5 mm, P = 0.048). Patients whose esophageal tortuosity did not improve had longer durations of symptoms than patients with improvement (80.2 vs 636 months, P < 0.001). An absence of peristalsis was observed in all patients pre- and post-POEM.

Conclusions: POEM resulted in excellent clinical outcomes and morphologic improvement in sigmoid-type achalasia. These results suggest that the improvement of esophageal tortuosity through POEM reflects a reduced esophageal burden.
Files in This Item:
T202001163.pdf Download
DOI
10.5056/jnm19144
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
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
Yoon, Hong Jin(윤홍진) ORCID logo https://orcid.org/0000-0002-4880-3262
Lee, Jung Eun(이정은B)
Jung, Da Hyun(정다현) ORCID logo https://orcid.org/0000-0001-6668-3113
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/175998
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