SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Très original
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gastrointestinal Endoscopy
  2017/06  
 
  2017 Jun;85(6):1208-1211  
  doi: 10.1016/j.gie.2016.10.015.  
 
  A multicenter international registry of redo per-oral endoscopic myotomy (POEM) after failed POEM  
 
  Tyberg A, Seewald S, Sharaiha RZ, Martinez G, Desai AP, Kumta NA, Lambroza A, Sethi A, Reavis KM, DeRoche K, Gaidhane M, Talbot M, Saxena P, Zamarripa F, Barret M, Eleftheriadis N, Balassone V, Inoue H, Kahaleh M  
  https://www.ncbi.nlm.nih.gov/pubmed/27756611  
 
 

Abstract

BACKGROUND AND AIMS:

Per-oral endoscopic myotomy (POEM) has become an accepted treatment for patients with achalasia. Despite its excellent efficacy rate of greater than 80%, a small percentage of patients remain symptomatic after the procedure. Limited data exist as to the best management for recurrence of symptoms after POEM. We present the first international, multicenter experience on the efficacy and safety of a repeat POEM in the management of achalasia.

METHODS:

Patients who underwent a redo POEM from 15 centers in 9 countries were included in a dedicated registry. Technical success was defined as successful completion of a second myotomy. Clinical success was defined as an Eckardt score of less than or equal to 3 after the second myotomy. Adverse events including anesthesia-related, operative, and postoperative adverse events were recorded.

RESULTS:

Forty-six patients were included in the study. The average age was 49.3 ± 16.78 years. Twenty (45%) patients were male. The mean pre-redo-POEM Eckardt score was 4.3 ± 2.48. Technical success was achieved in 46 (100%) patients. Clinical success was achieved in 41 patients (85%). The average post-POEM Eckardt score was 1.64 ± 1.67, with a significant difference of 2.58 (P < .00001). Eight patients (17%) had adverse events consisting of procedural bleeding, all managed endoscopically. There were no deaths. No POEMs were aborted or required surgical conversion or assistance.

DISCUSSION:

For patients with persistent symptoms after POEM, repeat POEM appears to be an efficacious and safe technique. Further randomized trials comparing redo POEM versus Heller should be considered. (Clinical trial registration number: NCT02162589.).

 
 
Question posée
 
Quels sont les résultats du re-POEM en cas d’échec du POEM initial ?
 
Question posée
 
Le succès technique est de 100% et le succès clinique de 85% au prix de 17% d’hémorragies post-procédures, toutes gérées endoscopiquement.
 
Commentaires

Cette étude internationale multicentrique est en faveur de la réalisation d’un nouveau POEM en cas de persistance des symptômes après le POEM initial. Il n’y a en revanche aucune donnée sur les résultats à long terme de cette stratégie … 

 
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