Peroral endoscopic myotomy as an emergent treatment in hospitalized patients with esophageal motility disorders.
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Fayyaz Farimah, Roshanshad Romina, Jagannath Preethi, Almardini Michel, Bejjani Michael, Wehbe Mohamad, Hernández Mondragón Oscar Víctor, Robles Marcel, Schlachterman Alexander, Le Joria, Chang Kenneth, Dang Frances, Hwang Joo Ha, Li Andrew A, Sadeghi Majd Elham, Eleftheriadis Nikolas, Bechara Robert, Parvizian Michael, Yoo In Kyung, Pioche Mathieu, Moll Frédéric, Kim Raymond E, Canakis Andrew, Othman Mohamed, Jawaid Salmaan, Khalaf Mai Ahmed, Estremera-Arevalo Fermín, Albéniz Arbizu Eduardo, Inoue Haruhiro, Shiwaku Hironari, Lajin Michael, Chung Chen-Shuan, Seewald Stefan, Pawa Rishi, Pawa Swati, Khashab Mouen
Аннотация
METHODS: This retrospective multicenter study included patients aged ≥18 years who were hospitalized for severe symptoms of esophageal motility disorders and underwent emergent POEM during the same admission at 17 international centers from March 2012 to January 2024.
RESULTS: One hundred seventy-nine patients (57% women; mean age, 56 ± 21 years) were included. Of these, 160 had achalasia (type I, 40 [22.3%]; type II, 89 [49.7%]; type III, 31 [17.3%]), and 19 had nonachalasia disorders including esophagogastric junction outflow obstruction (n = 9), jackhammer esophagus (n = 1), distal esophageal spasm (n = 1), and unknown diagnosis (n = 8). The median baseline Eckardt score (ES) was 9 (IQR, 8-11). At admission, 57.1% of patients were on a nonoral diet and 36.2% were on a liquid-only diet. POEM was technically successful in 176 patients (98.3%). At discharge, 79 patients (44.9%) were on a liquid-only diet, 79 (44.9%) on soft solids, and 18 (10.2%) were on a complete diet, representing a significant dietary improvement (P < .001). The median ES improved to 1 (IQR, 1-2) at discharge (P < .001). Adverse events occurred in 4 patients (2.3%), including 2 mild (managed conservatively), 1 moderate (bleeding treated with clips), and 1 severe (leak managed with clips). The median post-POEM hospital stay was 2 days (IQR, 1-4). Clinical success, defined as ES ≤3, was achieved in 81.9% of patients at a median of 45.5 weeks. The median ES at follow-up decreased to 1 (IQR, 0-3; P < .001).
CONCLUSIONS: POEM is a safe and highly effective emergent treatment in hospitalized patients with esophageal motility disorders and acute feeding incapacity, providing rapid symptom relief and significant dietary improvement.