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Thématique :
- Endoscopie/Imagerie
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Originalité :
Intermédiaire
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Doit faire évoluer notre pratique : |
Dans certains cas
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Nom du veilleur :
Docteur Florian ROSTAIN
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Endoscopy
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2017/05
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2017 May
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doi: 10.1055/s-0043-105485
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Gastroesophageal reflux after peroral endoscopic myotomy: a multicenter case-control study.
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Kumbhari V, Familiari P, Bjerregaard NC, Pioche M, Jones E, Ko WJ, Hayee B, Cali A, Ngamruengphong S, Mion F, Hernaez R, Roman S, Tieu AH, El Zein M, Ajayi T, Haji A, Cho JY, Hazey J, Perry KA, Ponchon T, Kunda R, Costamagna G, Khashab MA
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https://www.ncbi.nlm.nih.gov/pubmed/28472834
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Abstract
Background and study aims The variables associated with gastroesophageal reflux (GER) after peroral endoscopic myotomy (POEM) are largely unknown. This study aimed to: 1) identify the prevalence of reflux esophagitis and asymptomatic GER in patients who underwent POEM, and 2) evaluate patient and intraprocedural variables associated with post-POEM GER.
Patients and methods All patients who underwent POEM and subsequent objective testing for GER (pH study with or without upper gastrointestinal [GI] endoscopy) at seven tertiary academic centers (one Asian, two US, four European) were included. Patients were divided into two groups: 1) DeMeester score ≥ 14.72 (cases) and 2) DeMeester score of < 14.72 (controls). Asymptomatic GER was defined as a patient with a DeMeester score ≥ 14.72 who was not consuming proton pump inhibitor (PPI).
Results A total of 282 patients (female 48.2 %, Caucasian 84.8 %; mean body mass index 24.1 kg/m2) were included. Clinical success was achieved in 94.3 % of patients. GER evaluation was completed after a median follow-up of 12 months (interquartile range 10 - 24 months). A DeMeester score of ≥ 14.72 was seen in 57.8 % of patients. Multivariable analysis revealed female sex to be the only independent association (odds ratio 1.69, 95 % confidence interval 1.04 - 2.74) with post-POEM GER. No intraprocedural variables were associated with GER. Upper GI endoscopy was available in 233 patients, 54 (23.2 %) of whom were noted to have reflux esophagitis (majority Los Angeles Grade A or B). GER was asymptomatic in 60.1 %.
Conclusion Post-POEM GER was seen in the majority of patients. No intraprocedural variables were identified to allow for potential alteration in procedural technique.
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Quelle est la prévalence du Reflux Gastro Oesophagien RGO symptomatique et asymptomatique chez le patient ayant eu une peroral myotomie endoscopique POEM ?
Quels sont les facteurs associés à un RGO post-POEM, liés au patient et à l’intervention elle-même ?
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Etude cas-contrôle multicentrique sur 282 patients ayant eu un POEM.
Succès clinique : 94,3%
Un RGO post-POEM (défini par un score DeMeester> 14,72) était présent chez 57,8% des patients. Seul le sexe féminin était associé à un risque de RGO post-POEM.
Parmi les 233 patients ayant eu une endoscopie après le POEM, 54 (23,2%) avaient des signes d’oesophagite (majorité de grade A et B de Los Angeles).
Le RGO était asymptomatique dans 60% des cas.
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Etude montrant l’existence d’un RGO authentifié chez presque 6 patients sur 10 après un POEM. Toutefois le RGO est asymptomatique dans 60% des cas. Mise à part le sexe féminin il n’y a pas de facteur prédictif d’un RGO-POEM.
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