Peroral endoscopic myotomy for hypercontractile (Jackhammer) esophagus: A retrospective multicenter series with long-term follow-up.
Eckardt score
Jackhammer esophagus
adverse events
esophagogastric junction outflow obstruction (EGJOO)
failure
lower esophageal sphincter (LES)
motility
peroral endoscopic myotomy (POEM)
Journal
United European gastroenterology journal
ISSN: 2050-6414
Titre abrégé: United European Gastroenterol J
Pays: England
ID NLM: 101606807
Informations de publication
Date de publication:
14 Jun 2024
14 Jun 2024
Historique:
received:
19
05
2023
accepted:
22
03
2024
medline:
14
6
2024
pubmed:
14
6
2024
entrez:
14
6
2024
Statut:
aheadofprint
Résumé
Long-term outcome data are limited for non-achalasia esophageal motility disorders treated by peroral endoscopy myotomy (POEM) as a separate group. We investigated a subset of symptomatic patients with hypercontractile esophagus (Jackhammer esophagus). Forty two patients (mean age 60.9 years; 57% female, mean Eckardt score 6.2 ± 2.1) treated by primary peroral myotomy for symptomatic Jackhammer esophagus 2012-2018 in seven European centers were retrospectively analyzed; myotomy included the lower esophageal sphincter but did not extend more than 1 cm into the cardia in contrast to POEM for achalasia. Manometry data were re-reviewed by an independent expert. The main outcome was the failure rate defined by retreatment or an Eckardt score >3 after at least two years following POEM. Despite 100% technical success (mean intervention time 107 ± 48.9 min, mean myotomy length 16.2 ± 3.7 cm), the 2-year success rate was 64.3% in the entire group. In a subgroup analysis, POEM failure rates were significantly different between Jackhammer-patients without (n = 22), and with esophagogastric junction outflow obstruction (EGJOO, n = 20) (13.6% % vs. 60%, p = 0.003) at a follow-up of 46.5 ± 19.0 months. Adverse events occurred in nine cases (21.4%). 14 (33.3%) patients were retreated, two with surgical fundoplication due to reflux. Including retreatments, an improvement in symptom severity was found in 33 (78.6%) at the end of follow-up (Eckardt score ≤3, mean Eckardt change 4.34, p < 0.001). EGJOO (p = 0.01) and frequency of hypercontractile swallows (p = 0.02) were predictors of POEM failure. The development of a pseudodiverticulum was observed in four cases within the subgroup of EGJOO. Patients with symptomatic Jackhammer without EGJOO benefit from POEM in long-term follow-up. Treatment of Jackhammer with EGJOO, however, remains challenging and probably requires full sphincter myotomy and future studies which should address the pathogenesis of this variant and alternative strategies.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.
Références
Yadlapati R, Kahrilas PJ, Fox MR, Bredenoord AJ, Prakash Gyawali C, Roman S, et al. Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0(©). Neuro Gastroenterol Motil. 2020;33(1):e14058. https://doi.org/10.1111/nmo.14058
Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJPM, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neuro Gastroenterol Motil. 2015;27(2):160–174. https://doi.org/10.1111/nmo.12477
Jung HY, Puckett JL, Bhalla V, Rojas‐Feria M, Bhargava V, Liu J, et al. Asynchrony between the circular and the longitudinal muscle contraction in patients with nutcracker esophagus. Gastroenterology. 2005;128(5):1179–1186. https://doi.org/10.1053/j.gastro.2005.02.002
Korsapati H, Bhargava V, Mittal RK. Reversal of asynchrony between circular and longitudinal muscle contraction in nutcracker esophagus by atropine. Gastroenterology. 2008;135(3):796–802. https://doi.org/10.1053/j.gastro.2008.05.082
Mauro A, Quader F, Tolone S, Savarino E, De Bortoli N, Franchina M, et al. Provocative testing in patients with jackhammer esophagus: evidence for altered neural control. Am J Physiol Gastrointest Liver Physiol. 2019;316(3):G397–G403. https://doi.org/10.1152/ajpgi.00342.2018
de Bortoli N, Gyawali PC, Roman S, Tolone S, Sifrim D, Tutuian R, et al. Hypercontractile esophagus from pathophysiology to management: proceedings of the pisa symposium. Am J Gastroenterol. 2021;116(2):263–273. https://doi.org/10.14309/ajg.0000000000001061
Philonenko S, Roman S, Zerbib F, Gourcerol G, Gault N, Ropert A, et al. Jackhammer esophagus: clinical presentation, manometric diagnosis, and therapeutic results ‐ results from a multicenter French cohort. Neuro Gastroenterol Motil. 2020;32:e13918. https://doi.org/10.1111/nmo.13918
Mion F, Marjoux S, Subtil F, Pioche M, Rivory J, Roman S, et al. Botulinum toxin for the treatment of hypercontractile esophagus: results of a double‐blind randomized sham‐controlled study. Neuro Gastroenterol Motil. 2019;31(5):e13587. https://doi.org/10.1111/nmo.13587
Schupack D, Katzka DA, Geno DM, Ravi K. The clinical significance of esophagogastric junction outflow obstruction and hypercontractile esophagus in high resolution esophageal manometry. Neuro Gastroenterol Motil. 2017;29(10):1–9. https://doi.org/10.1111/nmo.13105
Huang L, Pimentel M, Rezaie A. Do Jackhammer contractions lead to achalasia? A longitudinal study. Neuro Gastroenterol Motil. 2017;29(3):e12953. https://doi.org/10.1111/nmo.12953
Quader F, Mauro A, Savarino E, Tolone S, de Bortoli N, Franchina M, et al. Jackhammer esophagus with and without esophagogastroc junction outflow obstruction demonstrates altered neural control resembling type 3 achalasia. Neuro Gastroenterol Motil. 2019;31(9):e13678. https://doi.org/10.1111/nmo.13678
Wahba G, Bouin M. Jackhammer esophagus: a meta‐analysis of patient demographics, disease presentation, high‐resolution manometry data, and treatment outcomes. Neuro Gastroenterol Motil. 2020;32(11):e13870. https://doi.org/10.1111/nmo.13870
Vanuytsel T, Bisschops R, Farré R, Pauwels A, Holvoet L, Arts J, et al. Botulinum toxin reduces Dysphagia in patients with nonachalasia primary esophageal motility disorders. Clin Gastroenterol Hepatol. 2013;11(9):1115–1121.e2. https://doi.org/10.1016/j.cgh.2013.03.021
Ko WJ, Lee BM, Park WY, Kim JN, Cho JH, Lee TH, et al. Jackhammer esophagus treated by a peroral endoscopic myotomy. Korean J Gastroenterol. 2014;64(6):370–374. https://doi.org/10.4166/kjg.2014.64.6.370
Khashab MA, Messallam AA, Onimaru M, Teitelbaum EN, Ujiki MB, Gitelis ME, et al. International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video). Gastrointest Endosc. 2015;81(5):1170–1177. https://doi.org/10.1016/j.gie.2014.10.011
Bechara R, Ikeda H, Inoue H. Peroral endoscopic myotomy for Jackhammer esophagus: to cut or not to cut the lower esophageal sphincter. Endosc Int Open. 2016;4(05):E585–E588. https://doi.org/10.1055/s‐0042‐105204
Kandulski A, Fuchs KH, Weigt J, Malfertheiner P. Jackhammer esophagus: high‐resolution manometry and therapeutic approach using peroral endoscopic myotomy (POEM). Dis Esophagus. 2016;29:695–696. https://doi.org/10.1111/dote.12182
Dawod E, Saumoy M, Xu MM, Kahaleh M. Peroral endoscopic myotomy (POEM) in Jackhammer esophagus: a trick of the trade. Endoscopy. 2017;49(10):E254–e255. https://doi.org/10.1055/s‐0043‐115887
Khashab MA, Familiari P, Draganov PV, Aridi HD, Cho JY, Ujiki M, et al. Peroral endoscopic myotomy is effective and safe in non‐achalasia esophageal motility disorders: an international multicenter study. Endosc Int Open. 2018;6(08):E1031–e1036. https://doi.org/10.1055/a‐0625‐6288
Filicori F, Dunst CM, Sharata A, Abdelmoaty WF, Zihni AM, Reavis KM, et al. Long‐term outcomes following POEM for non‐achalasia motility disorders of the esophagus. Surg Endosc. 2019;33(5):1632–1639. https://doi.org/10.1007/s00464‐018‐6438‐z
Choi YI, Kim KO, Park DK, Chung JW, Kwon KA. Clinical outcomes and safety of high‐resolution manometry guided superficial partial circular muscle myotomy in per‐oral endoscopic myotomy for Jackhammer esophagus: two cases report. World J Clin Cases. 2019;7(16):2322–2329. https://doi.org/10.12998/wjcc.v7.i16.2322
Albers D, Frieling T, Dakkak D, Kuhlbusch‐Zicklam R, Töx U, Gittinger M, et al. Peroral endoscopic myotomy (POEM) is effective in treatment of noncardiac chest pain caused by hypercontractile esophageal motility disorders: results of the POEM‐HYPE‐Study. Z Gastroenterol. 2018;56(11):1337–1342. https://doi.org/10.1055/a‐0668‐2605
Bernardot L, Roman S, Barret M, Vitton V, Wallenhorst T, Pioche M, et al. Efficacy of per‐oral endoscopic myotomy for the treatment of non‐achalasia esophageal motor disorders. Surg Endosc. 2020;34(12):5508–5515. https://doi.org/10.1007/s00464‐019‐07348‐y
Nabi Z, Chavan R, Ramchandani M, Basha J, Jagtap N, Karyampudi A, et al. Long‐term outcomes of per‐oral endoscopic myotomy in spastic esophageal motility disorders: a large, single‐center study. J Clin Gastroenterol. 2021;55(7):594–601. https://doi.org/10.1097/mcg.0000000000001395
Nakamura J, Hikichi T, Hashimoto M, Takasumi M, Kato T, Kobashi R, et al. Efficacy and safety of peroral endoscopic myotomy for esophageal achalasia and achalasia‐related diseases in patients aged 75 Years and over. Healthc (Basel). 2021;9(12):1668. https://doi.org/10.3390/healthcare9121668
Canakis A, Xie G, Kim RE. Peroral endoscopic myotomy is an effective treatment option for managing jackhammer esophagus: a single center experience. J Clin Gastroenterol. 2023;57(6):569–573.
Estremera‐Arévalo F, González G, Areste I, et al. Outcomes of per‐oral endoscopic myotomy in patients with spastic esophageal motility disorders not fulfilling Chicago Classification criteria. Rev Esp Enferm Dig. 2022:114(11):641–647.
Hosaka H, Kawami N, Manabe N, Kuribayashi S, Sato H, Funaki Y, et al. Clinical presentation and therapeutic outcome of patients with jackhammer esophagus‐a multicenter cohort study in Japan. Esophagus. 2022;19(3):393–400. https://doi.org/10.1007/s10388‐022‐00916‐7
Werner YB, von Renteln D, Noder T, Schachschal G, Denzer UW, Groth S, et al. Early adverse events of per‐oral endoscopic myotomy. Gastrointest Endosc. 2017;85(4):708–718e2. https://doi.org/10.1016/j.gie.2016.08.033
Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. 1992;103(6):1732–1738. https://doi.org/10.1016/0016‐5085(92)91428‐7
Ponds FA, Fockens P, Lei A, Neuhaus H, Beyna T, Kandler J, Frieling T, et al. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment‐naive patients with achalasia. A randomized clinical trial. JAMA. 2019;322(2):134–144. https://doi.org/10.1001/jama.2019.8859
Werner YB, Hakanson B, Martinek J, Repici A, von Rahden BH, Bredenoord AJ, et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. N Engl J Med. 2019;381(23):2219–2229. https://doi.org/10.1056/nejmoa1905380
Von Renteln D, Fuchs KH, Fockens P, Bauerfeind P, Vassiliou MC, Werner YB, et al. Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology. 2013;145(2):309–311.e1‐3. https://doi.org/10.1053/j.gastro.2013.04.057
Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71(3):446–454. https://doi.org/10.1016/j.gie.2009.10.027
Nass KJ, Zwager LW, van der Vlugt M, Dekker E, Bossuyt PM, Ravindran S, et al. Novel classification for adverse events in GI endoscopy: the AGREE classification. Gastrointest Endosc. 2022;95(6):1078–1085.e8. https://doi.org/10.1016/j.gie.2021.11.038
Team RC. A language and environment for statistical computing. Vienna: Foundation for Statistical Computing; 2021. https://www.R‐project.org/
Herregods TV, Smout AJ, Ooi JL, Sifrim D, Bredenoord AJ. Jackhammer esophagus: observations on a European cohort. Neuro Gastroenterol Motil. 2017;29(4). https://doi.org/10.1111/nmo.12975
Kahn A, Al‐Qaisi MT, Obeid RA, Katzka DA, Ravi KM, Ramirez FC, et al. Clinical features and long‐term outcomes of lower esophageal sphincter‐dependent and lower esophageal sphincter‐independent Jackhammer esophagus. Neuro Gastroenterol Motil. 2019;31(2):e13507. https://doi.org/10.1111/nmo.13507
Roman S, Pandolfino JE, Chen J, Boris L, Luger D, Kahrilas PJ. Phenotypes and clinical context of hypercontractility in high‐resolution esophageal pressure topography (EPT). Am J Gastroenterol. 2012;107(1):37–45. https://doi.org/10.1038/ajg.2011.313
Chandan S, Mohan BP, Chandan OC, Jha LK, Mashiana HS, Hewlett AT, et al. Clinical efficacy of per‐oral endoscopic myotomy (POEM) for spastic esophageal disorders: a systematic review and meta‐analysis. Surg Endosc. 2020;34(2):707–718. https://doi.org/10.1007/s00464‐019‐06819‐6
Khan MA, Kumbhari V, Ngamruengphong S, Ismail A, Chen YI, Chavez YH, et al. Is POEM the answer for management of spastic esophageal disorders? A systematic review and meta‐analysis. Dig Dis Sci. 2017;62(1):35–44. https://doi.org/10.1007/s10620‐016‐4373‐1
Triggs JR, Krause AJ, Carlson DA, Donnan EN, Campagna RA, Jain AS, et al. Blown‐out myotomy: an adverse event of laparoscopic Heller myotomy and peroral endoscopic myotomy for achalasia. Gastrointest Endosc. 2021;93(4):861–868.e1. https://doi.org/10.1016/j.gie.2020.07.041