Digestive Endoscopy 2016; 28: 33–41
doi: 10.1111/den.12511
Original Article
Gastroesophageal reflux disease after peroral endoscopic myotomy: Analysis of clinical, procedural and functional factors, associated with gastroesophageal reflux disease and esophagitis Pietro Familiari,1* Santi Greco,1 Giovanni Gigante,1 Anna Calì,1 Ivo Boškoski,1 Graziano Onder,2 Vincenzo Perri1 and Guido Costamagna1 1
Digestive Endoscopy Unit, and 2Department of Geriatrics, Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy Background and Aim: Peroral endoscopic myotomy (POEM) does not include any antireflux procedure, resulting in a certain risk of iatrogenic gastroesophageal reflux disease (GERD). The aim of the present study was to evaluate the incidence of iatrogenic GERD after POEM and identify preoperative, perioperative and postoperative factors associated with GERD. Methods: All patients treated at a single center who had a complete GERD evaluation after POEM were included in the study. Demographics, preoperative and follow-up data, results of functional studies and procedural data were collected and analyzed.
Results: A total of 103 patients (mean age 46.6 years, 47 males) were included. Postoperative altered esophageal acid exposure was attested in 52 patients (50.5%). A total of 19 patients (18.4%) had heartburn and 21 had esophagitis (20.4%). Overall, a clinically relevant GERD (altered esophageal acid exposure, associated with heartburn and/or esophagitis) was diagnosed in 30 patients (29.1%).
INTRODUCTION CHALASIA IS A rare disorder characterized by alteration of esophageal peristalsis and absence of lower esophageal sphincter (LES) relaxation caused by a myenteric plexus damage of unknown etiology.1,2 Gastroesophageal reflux disease (GERD) is one of the most frequent complications after any treatment of achalasia. All therapeutic options have the common target of reducing LES pressure to improve esophageal emptying. However, lowering LES pressure can result in potential GERD. Therefore, to avoid
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Corresponding: Pietro Familiari, Digestive Endoscopy Unit, Gemelli University Hospital Largo Gemelli, 8–00168 – Rome, RM – Italy. Email: [email protected] Received 23 February 2015; accepted 8 July 2015.
Correlation between the severity of esophageal acid exposure with heartburn and esophagitis after POEM was found. Patients with heartburn had a lower postoperative 4-second integrated relaxation pressure compared to patients without symptoms (7.6 ± 3.8 mmHg vs 10.01 ± 4.4 mmHg, p
doi: 10.1111/den.12511
Original Article
Gastroesophageal reflux disease after peroral endoscopic myotomy: Analysis of clinical, procedural and functional factors, associated with gastroesophageal reflux disease and esophagitis Pietro Familiari,1* Santi Greco,1 Giovanni Gigante,1 Anna Calì,1 Ivo Boškoski,1 Graziano Onder,2 Vincenzo Perri1 and Guido Costamagna1 1
Digestive Endoscopy Unit, and 2Department of Geriatrics, Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy Background and Aim: Peroral endoscopic myotomy (POEM) does not include any antireflux procedure, resulting in a certain risk of iatrogenic gastroesophageal reflux disease (GERD). The aim of the present study was to evaluate the incidence of iatrogenic GERD after POEM and identify preoperative, perioperative and postoperative factors associated with GERD. Methods: All patients treated at a single center who had a complete GERD evaluation after POEM were included in the study. Demographics, preoperative and follow-up data, results of functional studies and procedural data were collected and analyzed.
Results: A total of 103 patients (mean age 46.6 years, 47 males) were included. Postoperative altered esophageal acid exposure was attested in 52 patients (50.5%). A total of 19 patients (18.4%) had heartburn and 21 had esophagitis (20.4%). Overall, a clinically relevant GERD (altered esophageal acid exposure, associated with heartburn and/or esophagitis) was diagnosed in 30 patients (29.1%).
INTRODUCTION CHALASIA IS A rare disorder characterized by alteration of esophageal peristalsis and absence of lower esophageal sphincter (LES) relaxation caused by a myenteric plexus damage of unknown etiology.1,2 Gastroesophageal reflux disease (GERD) is one of the most frequent complications after any treatment of achalasia. All therapeutic options have the common target of reducing LES pressure to improve esophageal emptying. However, lowering LES pressure can result in potential GERD. Therefore, to avoid
A
bs_bs_banner
Corresponding: Pietro Familiari, Digestive Endoscopy Unit, Gemelli University Hospital Largo Gemelli, 8–00168 – Rome, RM – Italy. Email: [email protected] Received 23 February 2015; accepted 8 July 2015.
Correlation between the severity of esophageal acid exposure with heartburn and esophagitis after POEM was found. Patients with heartburn had a lower postoperative 4-second integrated relaxation pressure compared to patients without symptoms (7.6 ± 3.8 mmHg vs 10.01 ± 4.4 mmHg, p
