Gastrointestinal endoscopy · 2024
Repeat peroral endoscopic myotomy: technical difficulty and risk factors.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ma Li-Yun, Guo Ke-Yi, Liu Zu-Qiang, Chen Shi-Yao, Zhong Yun-Shi, Zhang Yi-Qun, Chen Wei-Feng, Ma Li-Li, Qin Wen-Zheng, Hu Jian-Wei, Cai Ming-Yan, Yao Li-Qing, Li Quan-Lin, Zhou Ping-Hong
Аннотация
BACKGROUND AND AIMS: Repeat peroral endoscopic myotomy (Re-POEM) appears to be a promising salvage option for patients with persistent or recurrent symptoms after initial POEM, but it may be more technically challenging. Here we aim to evaluate the safety and technical difficulty of Re-POEM.
METHODS: Between July 2012 and October 2023, 158 achalasia patients underwent Re-POEM and were retrospectively enrolled. Another 2978 patients without prior myotomy were selected for the naïve POEM group. After propensity score matching (PSM), procedure-related parameters were compared between the 2 groups. Univariable and multivariable analyses were performed to reveal risk factors for difficult Re-POEM (defined as procedure time ≥90 minutes).
RESULTS: With similar baseline characteristics between the 2 groups after PSM, the procedure time was comparable between Re-POEM and naïve POEM groups (61.4 ± 27.0 vs 59.3 ± 29.9, P = .496). The Re-POEM group had a shorter esophageal myotomy length (7.0 ± 2.1 cm vs 8.2 ± 1.1 cm, P < .001) and longer gastric myotomy length (2.3 ± .6 cm vs 2.1 ± .4 cm, P = .017) compared with the naïve POEM group. Mucosal injury in the Re-POEM group was slightly higher, which was not statistically significant (20.3% vs 13.9%, P = .135). No differences were found in the incidence of gas-related adverse events (AEs), major AEs, and technical difficulty. Multivariate analysis determined mucosal edema (odds ratio, 4.942; 95% confidence interval, 1.554-15.714; P = .007) and submucosal fibrosis (odds ratio, 3.817; 95% confidence interval, 1.333-10.931; P = .013) to be independent risk factors for difficult Re-POEM.
CONCLUSIONS: Re-POEM appears to be safe and feasible as a salvage option after initial POEM failure, with comparable procedure duration, incidence of AEs, and technical difficulty with naïve POEM. Mucosal edema and submucosal fibrosis were associated with difficult Re-POEM.
METHODS: Between July 2012 and October 2023, 158 achalasia patients underwent Re-POEM and were retrospectively enrolled. Another 2978 patients without prior myotomy were selected for the naïve POEM group. After propensity score matching (PSM), procedure-related parameters were compared between the 2 groups. Univariable and multivariable analyses were performed to reveal risk factors for difficult Re-POEM (defined as procedure time ≥90 minutes).
RESULTS: With similar baseline characteristics between the 2 groups after PSM, the procedure time was comparable between Re-POEM and naïve POEM groups (61.4 ± 27.0 vs 59.3 ± 29.9, P = .496). The Re-POEM group had a shorter esophageal myotomy length (7.0 ± 2.1 cm vs 8.2 ± 1.1 cm, P < .001) and longer gastric myotomy length (2.3 ± .6 cm vs 2.1 ± .4 cm, P = .017) compared with the naïve POEM group. Mucosal injury in the Re-POEM group was slightly higher, which was not statistically significant (20.3% vs 13.9%, P = .135). No differences were found in the incidence of gas-related adverse events (AEs), major AEs, and technical difficulty. Multivariate analysis determined mucosal edema (odds ratio, 4.942; 95% confidence interval, 1.554-15.714; P = .007) and submucosal fibrosis (odds ratio, 3.817; 95% confidence interval, 1.333-10.931; P = .013) to be independent risk factors for difficult Re-POEM.
CONCLUSIONS: Re-POEM appears to be safe and feasible as a salvage option after initial POEM failure, with comparable procedure duration, incidence of AEs, and technical difficulty with naïve POEM. Mucosal edema and submucosal fibrosis were associated with difficult Re-POEM.