SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Très original
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Florian ROSTAIN
Coup de coeur :
 
 
Gastrointestinal Endoscopy
  2017/05  
 
  2017 May. pii: S0016-5107(17)31861-8.  
  doi: 10.1016/j.gie.2017.04.036.  
 
  Management of recurrent symptoms after per-oral endoscopic myotomy in achalasia  
 
  van Hoeij FB, Ponds FA, Werner Y, Sternbach JM, Fockens P, Bastiaansen BA, Smout AJPM, Pandolfino JE, Rösch T, Bredenoord AJ  
  https://www.ncbi.nlm.nih.gov/pubmed/28478028  
 
 

Abstract

BACKGROUND AND AIMS:

Per-oral endoscopic myotomy (POEM) has been rapidly gaining ground as a treatment for achalasia. Although POEM is a safe and effective treatment, a subset of patients has persistent or recurrent symptoms after POEM. This study aimed to examine the efficacy of different retreatments after failed POEM.

METHODS:

POEM was performed on 441 patients with achalasia at 3 tertiary-care hospitals between 2010 and 2015. A review of prospectively collected data was conducted. All patients with achalasia with significant persistent or recurrent symptoms within 3 years after POEM, defined as an Eckardt symptom score >3, were included.

RESULTS:

Forty-three of 441 patients (9.8%) had persistent or recurrent symptoms after POEM, of which 34 (8%) received 1 or more retreatments. Retreatment with laparoscopic Heller myotomy and retreatment with POEM showed a modest efficacy of 45% and 63%, respectively, whereas pneumatic dilatation showed a poor efficacy of only 0% to 20%, depending on the size of the balloon. Male patients were more likely to have retreatment failure than female patients (P = .038).

CONCLUSIONS:

In patients with achalasia with persistent or recurrent symptoms after failed POEM, retreatment with laparoscopic Heller myotomy or retreatment with POEM has a higher efficacy than retreatment with pneumatic dilatations. Failure of retreatment occurred more often in male patients.

 
Question posée
 
Quelle est l’efficacité des différents traitements après un premier échec de POEM pour traitement de l’achalasie?
 
Question posée
 
Etude sur 441 patients traités par POEM dans 3 centres tertiaires. Quarante-trois patient ont été considérés en échec du POEM (symptomes persistents ou récurrents 3 ans après le traitement avec un score Eckardt > 3), et parmi eux 34 ont eu un ou plusieurs re-traitement. Un traitement par myotomie de Heller laparoscopique et un second POEM ont monté une efficacité modeste de 45% et 65% respectivement. La dilatation pneumatique a montré une faible efficacité de 0 à 20% dépendant de la taille du ballon. Les hommes ont eu une moindre efficacité du retraitement que les femmes.
 
Commentaires

En cas d’échec d’un POEM, un second POEM ou une myotomie de Heller chirurgicale peuvent se discuter.

 
www.snfge.org