SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Vincent VALANTIN
Coup de coeur :
 
 
Endoscopy
  2019/04  
 
  2019 Apr;51(4):350-354.  
  doi: 10.1055/a-0802-8826.  
 
  Feasibility of the peroral endoscopic myotomy (POEM) procedure with a new small-caliber endoscope (thin-POEM) in patients with achalasia.  
 
  Hernandez Mondragón OV, González Martínez MA, Solórzano Pineda OM, Blancas Valencia JM, Hernández Reyes ML  
  https://www.ncbi.nlm.nih.gov/pubmed/30630196  
 
 

Abstract

BACKGROUND:

 Peroral endoscopic myotomy (POEM) is a recognized technique for patients with achalasia. We aimed to evaluate the feasibility of using a small-caliber endoscope (thin-POEM) to perform POEM in patients with achalasia.

METHODS:

 Naïve or previously treated patients were included between February 2016 and April 2018. A small-caliber (5.9 mm) nasoendoscope was used, with a modified closure method using cyanoacrylate. Strict follow-up was performed.

RESULTS:

 45 patients were included, aged 45.5 years (interquartile range [IQR] 22 - 69); 53 % (24/45) had type II achalasia. Median total time for thin-POEM was 54 minutes (IQR 37 - 77) and median myotomy length was 13.5 cm (IQR 6 - 20). Results pre-procedure and 3 months post were Eckardt score 10 vs. 1 (P < 0.001), integrated relaxation pressure (IRP) 25.3 vs. 8.5 mmHg (P < 0.001), and timed barium esophagram (TBE) 100 % severely delayed vs. 86 % normal (P < 0.001), respectively. Type III patients had the longest thin-POEM times (median 58 minutes [IQR 52 - 77]). Reflux was confirmed at 3 months clinically in 17 % of patients, endoscopically in 20 %, and on pH monitoring in 53 %. At 6 months and 12 months, 40 % and 33 % of patients remained positive on pH monitoring and were medically managed.

CONCLUSIONS:

 Thin-POEM seems to be a safe, effective, and efficient procedure for POEM in patients with achalasia, with good short-term follow-up results.

 

 
Question posée
 
Faisabilité du POEM à l'aide d’un naso-gastrosocope de diamètre 5.9 mm.
 
Question posée
 
Technique permettant d’obtenir des résultats identiques à la technique utilisant un endoscope de calibre standard. Diminution du diamètre du tunnel d’entrée entrainant une facilité de la fermeture: cyanoacrylate à la place des clips (5 à 6 en moyenne).
 
Commentaires

La réduction du diamètre doit permettre, à terme, de réduire la superficie de sous muqueuse disséquée et donc de réduire le temps d’intervention.

Facilité d’ouverture du Tunnel et de fermeture de celui-ci par colle de cyanoacrylate (réduction du coût).

Pas de complication supplémentaire.

 
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