TY - JOUR
T1 - An international multicenter study evaluating the clinical efficacy and safety of per-oral endoscopic myotomy in octogenarians
AU - Chen, Yen I.
AU - Inoue, Haruhiro
AU - Ujiki, Michael
AU - Draganov, Peter V.
AU - Colavita, Paul
AU - Mion, Francois
AU - Romanelli, John
AU - Chiu, Philip
AU - Balassone, Valerio
AU - Patel, Lava
AU - Abbas, Ali
AU - Yang, Dennis
AU - Dunst, Christy
AU - Pioche, Mathieu
AU - Roman, Sabine
AU - Rivory, Jérôme
AU - Ponchon, Thierry
AU - Desilets, David
AU - Maselli, Roberta
AU - Onimaru, Manabu
AU - Nakamura, Jun
AU - Hata, Yoshitaka
AU - Hajiyeva, Gulara
AU - Ismail, Amr
AU - Ngamruengphong, Saowanee
AU - Bukhari, Majidah
AU - Chavez, Yamile Haito
AU - Kumbhari, Vivek
AU - Repici, Alessandro
AU - Khashab, Mouen A.
N1 - Publisher Copyright:
© 2018 American Society for Gastrointestinal Endoscopy
PY - 2018/4
Y1 - 2018/4
N2 - Background and Aims: Per-oral endoscopic myotomy (POEM) for achalasia is particularly appealing in the elderly because it is minimally invasive. However, data in patients aged ≥80 years are scarce. The aim of this study was to assess the clinical outcome of POEM in octogenarians. Methods: This was a multicenter retrospective study at 8 centers. Consecutive octogenarians with achalasia who underwent POEM between 2010 and 2016 were included. Rates of technical success (completion of myotomy), clinical response (Eckardt score ≤3), and adverse events (severity graded as per American Society for Gastrointestinal Endoscopy lexicon) were assessed. Results: A total of 76 patients (47.4% female, mean age 84 years) underwent POEM for treatment of achalasia: type I, 17.1%; type II, 35.5%; type III, 17.1%; and unspecified, 30.3%. Overall, 41.1% were treatment naïve, whereas others had previous botulinum toxin injection and/or pneumatic dilation. The mean (± standard deviation [SD]) age-adjusted Charlson comorbidity index score was 6.2 ± 2.4, with the majority of patients having American Society of Anesthesiologists Physical Status Classification System (ASA) scores of II/III. Technical success was 93.4%, with a median follow-up of 256 days. Fourteen adverse events occurred in 11 patients (14.5%). There were 3 inadvertent mucosotomies, 6 cases of symptomatic capnoperitoneum and/or capnomediastinum, 2 esophageal leaks, 1 cardiac arrhythmia, and 2 other). The severities of these adverse events were mild (78.6%), moderate (14.3%), and severe (7.1%). Clinical success was achieved in 90.8% of patients, with a mean (± SD) Eckardt score reduction from 7.0 ± 2.3 to 0.8 ± 0.1 (P <.001), a median follow-up of 256 days, and interquartile range of 66 to 547. Conclusion: Although the rate of technical success may be somewhat lower and the rate of adverse events slightly higher than previously reported, our data suggest that POEM in octogenarians is safe and effective, supporting its role as a primary modality for achalasia in this patient population.
AB - Background and Aims: Per-oral endoscopic myotomy (POEM) for achalasia is particularly appealing in the elderly because it is minimally invasive. However, data in patients aged ≥80 years are scarce. The aim of this study was to assess the clinical outcome of POEM in octogenarians. Methods: This was a multicenter retrospective study at 8 centers. Consecutive octogenarians with achalasia who underwent POEM between 2010 and 2016 were included. Rates of technical success (completion of myotomy), clinical response (Eckardt score ≤3), and adverse events (severity graded as per American Society for Gastrointestinal Endoscopy lexicon) were assessed. Results: A total of 76 patients (47.4% female, mean age 84 years) underwent POEM for treatment of achalasia: type I, 17.1%; type II, 35.5%; type III, 17.1%; and unspecified, 30.3%. Overall, 41.1% were treatment naïve, whereas others had previous botulinum toxin injection and/or pneumatic dilation. The mean (± standard deviation [SD]) age-adjusted Charlson comorbidity index score was 6.2 ± 2.4, with the majority of patients having American Society of Anesthesiologists Physical Status Classification System (ASA) scores of II/III. Technical success was 93.4%, with a median follow-up of 256 days. Fourteen adverse events occurred in 11 patients (14.5%). There were 3 inadvertent mucosotomies, 6 cases of symptomatic capnoperitoneum and/or capnomediastinum, 2 esophageal leaks, 1 cardiac arrhythmia, and 2 other). The severities of these adverse events were mild (78.6%), moderate (14.3%), and severe (7.1%). Clinical success was achieved in 90.8% of patients, with a mean (± SD) Eckardt score reduction from 7.0 ± 2.3 to 0.8 ± 0.1 (P <.001), a median follow-up of 256 days, and interquartile range of 66 to 547. Conclusion: Although the rate of technical success may be somewhat lower and the rate of adverse events slightly higher than previously reported, our data suggest that POEM in octogenarians is safe and effective, supporting its role as a primary modality for achalasia in this patient population.
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U2 - 10.1016/j.gie.2017.02.007
DO - 10.1016/j.gie.2017.02.007
M3 - Article
C2 - 28235595
AN - SCOPUS:85017118081
SN - 0016-5107
VL - 87
SP - 956
EP - 961
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -