Esophagus最新文献

{"title":"Impact of taxanes after PD-1 blockade exposure in advanced esophageal squamous cell carcinoma.","authors":"Kazuhiro Shiraishi, Yuki Takeyasu, Shun Yamamoto, Kotoe Oshima, Hiroshi Imazeki, Hidekazu Hirano, Natsuko Okita, Hirokazu Shoji, Yoshitaka Honma, Satoru Iwasa, Atsuo Takasima, Ken Kato","doi":"10.1007/s10388-024-01085-5","DOIUrl":"10.1007/s10388-024-01085-5","url":null,"abstract":"<p><strong>Background: </strong>Programmed cell death-1 (PD-1) blockade improves survival in patients with advanced esophageal squamous cell carcinoma (ESCC). However, the efficacy of taxanes after exposure to PD-1 blockade remains unclear in patients with advanced ESCC.</p><p><strong>Methods: </strong>We retrospectively analyzed the clinical outcomes of advanced ESCC patients treated with taxanes (paclitaxel or docetaxel) with/without prior exposure to PD-1 blockade (Exposed /Naïve group) at National Cancer Center Hospital from June 2016 to December 2020.</p><p><strong>Results: </strong>Ninety-nine patients (Exposed group, n = 32; Naïve group, n = 67) were included. The objective response rate (ORR) of the Exposed group was significantly higher than that of the Naïve group (37.5% vs. 13.4%, p = 0.009). The median progression-free survival was similar between the Exposed and Naïve groups (3.8 vs. 2.8 months, HR 1.12, 95% CI 0.65-1.86, p = 0.66). PD-1 blockade exposure independently predicated higher ORR to taxanes in multivariate analysis. Grade ≥ 3 adverse events were comparable between the Exposed and Naïve groups (45.8% vs. 40.3%, p = 0.64).</p><p><strong>Conclusions: </strong>Taxanes following PD-1 blockade in advanced ESCC showed a higher ORR but similar PFS compared to taxanes without prior PD-1 exposure.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"539-545"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of per-oral endoscopic myotomy in non-achalasia esophageal motility disorders: a systematic review and meta-analysis.","authors":"Rajesh Puri, Suprabhat Giri, Sarat Chandra Panigrahi, Bipadabhanjan Mallick, Preetam Nath, Zubin Dev Sharma, Bimal Kumar Sahu","doi":"10.1007/s10388-024-01076-6","DOIUrl":"10.1007/s10388-024-01076-6","url":null,"abstract":"<p><p>Per‑oral endoscopic myotomy (POEM) is the preferred endoscopic modality for managing achalasia cardia. However, there are no recommendations on the role of POEM in non‑achalasia esophageal dysmotility disorders (NAEMD), including esophagogastric junction outflow obstruction (EGJOO), distal esophageal spasm (DES), and hypercontractile esophagus (HE). The present systematic review and meta-analysis aimed to assess the safety and efficacy of POEM in the treatment of NAEMD. MEDLINE, Embase, and Scopus were searched from inception to August 2023 for studies analyzing the outcome of POEM in NAEMD. Clinical success and adverse events were the main outcomes assessed. The event rates and their 95% confidence interval were calculated using a random effects model. A total of 11 studies with 271 patients were included in the final analysis. The pooled clinical success rate with POEM in NAEMD was 86.9% (82.9-90.9). On subgroup analysis, the pooled clinical success rates of POEM in DES and EGJOO were 97.8% (90.9-100.0) and 92.7% (86.3-95.1), which were significantly higher than in HE 81.2% (73.5-88.8). Data from limited studies showed that the pooled rate of improvement in dysphagia and chest pain was 88.5% (83.0-93.9) and 87.4% (80.5-94.4). The pooled incidence of overall AEs and serious AEs was 12.6% (5.7-19.5) and 0.3% (0.0-1.9), respectively. On follow-up, the pooled incidence of new-onset heartburn was 18.7% (11.1-26.2). POEM is a safe and efficacious treatment modality for the management of NAEMD with a lower clinical success in patients with HE. Further large-scale studies are required to validate the findings of the present analysis.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"419-429"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to chemotherapy could predict the prognosis of esophageal squamous cell carcinoma treated with neoadjuvant docetaxel, cisplatin, and fluorouracil (DCF) followed by surgery: long-term results in a single institute.","authors":"Yasuyoshi Sato, Kazuhiko Mori, Shinichiro Atsumi, Kei Sakamoto, Shuichiro Oya, Asami Okamoto, Masayuki Urabe, Yoshiyuki Miwa, Shoh Yajima, Koichi Yagi, Sachiyo Nomura, Hiroharu Yamashita, Yasuyuki Seto","doi":"10.1007/s10388-024-01062-y","DOIUrl":"10.1007/s10388-024-01062-y","url":null,"abstract":"<p><strong>Background: </strong>Preoperative chemotherapy with 5-fluorouracil and cisplatin (FP) followed by surgery has been considered a standard treatment for patients with stage II/III esophageal squamous cell carcinoma (ESCC) based on the results of a phase III trial (JCOG9907) in Japan. Subsequently, the phase III NExT trial (JCOG1109) revealed the survival benefit of the neoadjuvant DCF regimen, which adds docetaxel to FP, and it became a standard treatment. However, the long-term results and prognostic factors of neoadjuvant DCF therapy in the real world are unknown.</p><p><strong>Methods: </strong>We retrospectively investigated 50 patients with ESCC treated with neoadjuvant DCF therapy from July 2012 to December 2017 at The University of Tokyo Hospital.</p><p><strong>Results: </strong>Median overall survival (OS) and progression-free survival (PFS) were 32.3 [95% confidence interval (CI) 21.0-NA] and 10.0 months (95% CI 6.3-15.6), respectively. Median OS [not reached (95% CI 31.5-NA) vs. 21.4 months (95% CI 13.5-33.0); p = 0.028] and PFS [83.3 months (95% CI 6.4-NA) vs. 7.4 months (95% CI 6.0-12.8] were significantly longer in patients with an objective response than in non-responders. Of 44 surgical cases, median PFS tended to be longer in pathological lymph node metastasis-negative patients. Conversely, survival did not differ according to cStage (II/III vs. IV) or the average relative dose intensity (ARDI, ≥ 85% vs. < 85%).</p><p><strong>Discussion: </strong>The response to neoadjuvant DCF therapy could predict patient prognosis. Additionally, pN+ tended to increase the recurrence risk, whereas cStage and ARDI did not influence survival.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"514-522"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11405498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophagectomy for esophageal cancer in patients with a history of total pharyngolaryngectomy: a Japanese nationwide retrospective cohort study.","authors":"Akihiko Okamura, Masayuki Watanabe, Jun Okui, Kengo Kuriyama, Osamu Shiraishi, Takanori Kurogochi, Tetsuya Abe, Hiroshi Sato, Hiroshi Miyata, Yoshihiko Kawaguchi, Yusuke Sato, Hiroaki Nagano, Shinsuke Takeno, Masanobu Nakajima, Kentaro Matsuo, Kentaro Murakami, Katsushi Takebayashi, Sohei Matsumoto, Tomoyuki Okumura, Yoshihiro Kakeji, Koji Kono, Nobuhiko Oridate, Yasushi Toh, Hiroya Takeuchi, Yukio Katori","doi":"10.1007/s10388-024-01078-4","DOIUrl":"10.1007/s10388-024-01078-4","url":null,"abstract":"<p><strong>Background: </strong>Second primary esophageal cancer often develops in patients with head and neck cancer, and esophagectomy in patients with a history of total pharyngolaryngectomy (TPL) is challenging. However, the clinical outcomes of these patients have yet to be examined in a multicenter setting.</p><p><strong>Methods: </strong>We evaluated the surgical outcomes of a nationwide cohort of 62 patients who underwent esophagectomy for esophageal cancer with a history of TPL.</p><p><strong>Results: </strong>Ivor-Lewis and McKeown esophagectomies were performed in 32 (51.6%) and 30 (48.4%) patients, respectively. Postoperatively, 23 patients (37.1%) developed severe complications, and 7 patients (11.3%) required reoperation within 30 days. Pneumonia and anastomotic leakage occurred in 13 (21.0%) and 16 (25.8%) patients, respectively. Anastomotic leakage occurred more frequently in the McKeown group than in the Ivor-Lewis group (46.7% vs. 6.2%, P < 0.001). The adjusted odds ratio for anastomotic leakage in the McKeown group was 9.64 (95% confidence intervals (CI), 2.11-70.82, P = 0.008). Meanwhile, the 5-year overall survival rates were comparable between the groups (41.8% for Ivor-Lewis and 42.7% for McKeown), and the adjusted hazard ratio of overall survival was 1.44 (95% CI, 0.64-3.29; P = 0.381; Ivor-Lewis as the reference).</p><p><strong>Conclusions: </strong>In our cohort, anastomotic leakage occurred more frequently after McKeown than Ivor-Lewis esophagectomy, and almost half of patients in the McKeown group experienced leakage. Ivor-Lewis esophagectomy is preferred for decreasing anastomotic leakage when oncologically and technically feasible.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"438-446"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of cases for which esophageal endoscopic submucosal dissection under general anesthesia is recommended","authors":"Atsushi Goto, Koichi Hamabe, Shunsuke Ito, Shinichi Hashimoto, Jun Nishikawa, Taro Takami","doi":"10.1007/s10388-024-01086-4","DOIUrl":"https://doi.org/10.1007/s10388-024-01086-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background/aims</h3><p>Esophageal endoscopic submucosal dissection (ESD) performed under general anesthesia can potentially provide more stable treatment in difficult cases than that under sedation. We evaluated the clinical characteristics and outcomes of ESD performed under general anesthesia compared with those under propofol sedation and discussed the cases in which general anesthesia is recommended.</p><h3 data-test=\"abstract-sub-heading\">Patients and methods</h3><p>In total, 292 lesions in 265 consecutive patients undergoing esophageal ESD at Yamaguchi University Hospital from 2013 to 2023 were included in this retrospective study.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>ESD was performed under general anesthesia for 92 lesions in 81 patients and under propofol sedation for 200 lesions in 184 patients. Tumor long-axis diameter was larger (39.8 ± 14.4 mm vs. 32.4 ± 9.9 mm, <i>p</i> &lt; 0.01) and dissection speed was faster (10.5 ± 5.9 mm²/min vs. 7.5 ± 4.2 mm²/min, <i>p</i> &lt; 0.01) in the general anesthesia group versus the sedation group. In the sedation group, a treatment history of pharyngeal cancer was significantly associated with a slower dissection speed (<i>p</i> = 0.037). The sedation group showed higher frequencies of hypoxemia (0% vs 9.8%, <i>p</i> &lt; 0.01), interruption due to body movement (0% vs 13%, <i>p</i> &lt; 0.01), and acute adverse events (21.7% vs 33.5%, <i>p</i> = 0.05). A treatment history of pharyngeal cancer was shown to be the significant factor contributing to acute adverse events (<i>p</i> = 0.018).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Esophageal ESD under general anesthesia can be a treatment option in patients with difficulty in performing stable procedures with propofol sedation. Especially in patients with a treatment history of pharyngeal cancer in whom ESD is more difficult to be performed and who are at higher risk for acute adverse events, general anesthesia can be considered.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":"42 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The totally mechanical Collard technique for cervical esophagogastric anastomosis reduces anastomotic stricture compared with triangular anastomosis in minimally invasive esophagectomy with gastric conduit reconstruction through the retrosternal route: a propensity score-matched study","authors":"Hironobu Goto, Taro Oshikiri, Yasufumi Koterazawa, Ryuichiro Sawada, Taro Ikeda, Hitoshi Harada, Naoki Urakawa, Hiroshi Hasegawa, Shingo Kanaji, Kimihiro Yamashita, Takeru Matsuda, Yoshihiro Kakeji","doi":"10.1007/s10388-024-01088-2","DOIUrl":"https://doi.org/10.1007/s10388-024-01088-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Cervical esophagogastric anastomosis is conventionally performed using the McKeown esophagectomy. However, an optimal anastomotic technique has not yet been established. This study aimed to compare the clinical outcomes of triangular anastomosis (TA) and totally mechanical Collard anastomosis (TMCA) for cervical esophagogastric anastomosis during minimally invasive esophagectomy with gastric conduit reconstruction through the retrosternal route.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In this matched- cohort study, 117 patients who underwent minimally invasive esophagectomy between 2019 and 2024 were divided into TA and TMCA groups. The TA technique was performed between September 2019 and December 2021, and the TMCA technique was performed between January 2022 and January 2024. We then compared the surgical outcomes and postoperative complications (pneumonia, recurrent laryngeal nerve palsy, anastomotic leakage, and stricture) between the two groups.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Propensity score matching revealed that 40 patients were included in both the TA and TMCA groups. The rates of pneumonia, recurrent laryngeal nerve palsy, and anastomotic leakage were not significantly different between the two groups. However, the rate of anastomotic stricture was lower in the TMCA than in the TA group (2.5% vs. 27.5%, respectively, <i>P</i> = 0.003).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Compared with the TA technique, the TMCA technique reduced the rate of anastomotic stricture when performing cervical esophagogastric anastomosis during minimally invasive esophagectomy with gastric conduit reconstruction through the retrosternal route.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":"209 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeat endoscopic submucosal dissection close to the initial endoscopic submucosal dissection scar for superficial esophageal squamous cell carcinoma","authors":"Koki Matsuoka, Tsukasa Ishida, Tetsuya Yoshizaki, Yoshinobu Yamamoto, Mineo Iwatate, Yasuaki Kitamura, Tomoya Sako, Atsushi Ikeda, Takayuki Ose, Fumiaki Kawara, Ryusuke Ariyoshi, Yasushi Sano, Hirofumi Abe, Shinwa Tanaka, Toshitatsu Takao, Yoshinori Morita, Takashi Toyonaga, Toshio Shimokawa, Yuzo Kodama","doi":"10.1007/s10388-024-01074-8","DOIUrl":"https://doi.org/10.1007/s10388-024-01074-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Repeat endoscopic submucosal dissection for metachronous recurrence of esophageal squamous cell carcinoma close to previous endoscopic submucosal dissection scars is challenging. Therefore, this study evaluated the efficacy and safety of repeat endoscopic submucosal dissection for recurrent esophageal squamous cell carcinoma.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>The study included 1680 patients. After propensity score matching, esophageal endoscopic submucosal dissection-related outcomes were compared between the post-endoscopic submucosal dissection scar group (n = 91) and first endoscopic submucosal dissection group (n = 910). The Kaplan–Meier method and log-rank tests were used to compare both groups’ survival and local recurrence curves.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>After propensity score matching, the two groups showed no significant difference in <i>en bloc</i> resection rate (97.80% vs. 99.56%, <i>p</i> = 0.096), treatment time (64.75 min vs 61.33 min, <i>p</i> = 0.448), recurrence rate (3.30% vs. 2.20%, <i>p</i> = 0.458), and stricture rate (7.69% vs. 4.07%, <i>p</i> = 0.110). However, the perforation rate was higher in the post-endoscopic submucosal dissection scar group than in the first endoscopic submucosal dissection group (4.40% vs. 1.10%, <i>p</i> = 0.031). The 5-year overall survival rates in the post-endoscopic submucosal dissection scar and first endoscopic submucosal dissection groups were 88.6% and 89.0%, respectively.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Repeated esophageal endoscopic submucosal dissection for recurrent esophageal squamous cell carcinoma yielded satisfactory clinical outcomes and survival rates. Therefore, repeat endoscopic submucosal dissection may effectively treat esophageal squamous cell carcinoma recurrence close to the initial endoscopic submucosal dissection scars.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":"25 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141770559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Japanese Classification of Esophageal Cancer, 12th Edition: Part II.","authors":"Yuichiro Doki, Koji Tanaka, Hiroshi Kawachi, Yasuhiro Shirakawa, Yuko Kitagawa, Yasushi Toh, Takushi Yasuda, Masayuki Watanabe, Takashi Kamei, Tsuneo Oyama, Yasuyuki Seto, Kentaro Murakami, Tomio Arai, Manabu Muto, Shinji Mine","doi":"10.1007/s10388-024-01048-w","DOIUrl":"10.1007/s10388-024-01048-w","url":null,"abstract":"<p><p>This is the second half of English edition of Japanese Classification of Esophageal Cancer, 12th Edition that was published by the Japan Esophageal Society in 2022.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"216-269"},"PeriodicalIF":2.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11199314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140184093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transparency-enhancing technology allows the three-dimensional assessment of esophageal carcinoma obtained by endoscopic submucosal dissection.","authors":"Yuichi Asahina, Munetoshi Hinata, Asami Tanaka, Kaori Oshio, Haruki Ogawa, Makoto Aihara, Hiroshi Onodera, Tetsuo Ushiku","doi":"10.1007/s10388-024-01055-x","DOIUrl":"10.1007/s10388-024-01055-x","url":null,"abstract":"<p><strong>Background: </strong>Although much progress has been made in diagnosis of carcinomas, no established methods have been confirmed to elucidate their morphological features.</p><p><strong>Methods: </strong>Three-dimensional structure of esophageal carcinomas was assessed using transparency-enhancing technology. Endoscopically resected esophageal squamous cell carcinoma was fluorescently stained, optically cleared using a transparency-enhancing reagent called LUCID, and visualized using laser scanning microscopy. The resulting microscope images were converted to virtual HE images for observation using ImageJ software.</p><p><strong>Results: </strong>Microscopic observation and image editing enabled three-dimensional image reconstruction and conversion to virtual HE images. The structure of abnormal blood vessels in esophageal carcinoma recognized by endoscopy could be observed in the 3 dimensions. Squamous cell carcinoma and normal squamous epithelium could be distinguished in the virtual HE images.</p><p><strong>Conclusions: </strong>The results suggested that transparency-enhancing technology and virtual HE images may be feasible for clinical application and represent a novel histopathological method for evaluating endoscopically resected specimens.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"405-409"},"PeriodicalIF":2.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11199231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140145033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achalasia: laparoscopic Heller myotomy with fundoplication versus peroral endoscopic myotomy-a systematic review and meta-analysis.","authors":"Joana Sobral, Miguel Machado, José Pedro Barbosa, José Barbosa","doi":"10.1007/s10388-024-01063-x","DOIUrl":"10.1007/s10388-024-01063-x","url":null,"abstract":"<p><p>There are various therapeutic options for achalasia. Nevertheless, peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy with fundoplication (LHM) are distinguished by their efficacy and low incidence of complications. Compare POEM and LHM regarding several outcomes in patients with achalasia. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An exhaustive literature search was performed using PubMed, Web of Science, and Cochrane Library databases. Studies comparing several outcomes between POEM and LHM in patients with achalasia were included. Data on clinical success, operative time, intraoperative complications, length of stay, reintervention rates, postoperative pain, overall complications, occurrence of GERD symptoms, use of proton bomb inhibitors and esophagitis were extracted. Quality assessment of the included studies was performed using the MINORS scale. We included 20 retrospective observational studies with a combined total of 5139 participants. The results demonstrated that there was no statistically significant difference in terms of intraoperative complications, postoperative complications, reintervention rate, occurrence of GERD symptoms, GERD HRQL, use of proton pump inhibitors, and esophagitis between POEM and LHM groups. Conversely, POEM was associated with higher clinical success and shorter operative time, length of stay, and postoperative pain. This meta-analysis concludes that both POEM and LHM, are effective and safe treatments for achalasia. However, POEM demonstrates better results regarding clinical success, operative time, length of stay, postoperative pain, and a tendency towards lower recurrence.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"298-305"},"PeriodicalIF":2.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11199208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}