SNFGE SNFGE
 
Thématique :
- Colo-proctologie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Pauline JOUET
Coup de coeur :
 
 
Gut
  2019/01  
 
  2019 Jan. pii: gutjnl-2018-316544.  
  doi: 10.1136/gutjnl-2018-316544.  
 
  Outcomes of pneumatic dilatation and Heller's myotomy for achalasia in England between 2005 and 2016.  
 
  Harvey PR, Coupland B, Mytton J, Evison F, Patel P, Trudgill NJ  
  https://www.ncbi.nlm.nih.gov/pubmed/30606814/  
 
 

Abstract

INTRODUCTION:

Achalasia is a disorder characterised by failed relaxation of the lower oesophageal sphincter. The aim of this study was to examine, at a national level, the long-term outcomes of achalasia therapies.

METHODS:

Hospital Episode Statistics include diagnostic and procedural data for all English National Health Service-funded hospital admissions. Subjects with a code for achalasia who had their initial treatment between January 2006 and December 2015 were grouped by treatment; pneumatic dilatation (PD) or surgical Heller's myotomy (HM). Procedural failure was defined as time to a further episode of the same therapy or a change to a different therapy. Up to three PDs were permitted without being considered a therapy failure.

RESULTS:

6938 subjects were included; 3619 (52.2%) were men and median age at diagnosis was 59 (IQR 43-75) years. 4748 (68.4%) initially received PD and 2190 (31.6%) HM. The perforation rate following PD was 1.6%. Mortality at 30 days was 0.0% for HM and 1.9% for PD, and <8% after perforation following PD. Factors associated with increased mortality after PD included age quintile 66-77 (OR 4.55 (95% CI 2.00 to 10.38), p<0.001), >77 (9.78 (4.33 to 22.06), p<0.001); Charlson comorbidity score >4 (2.87 (2.08 to 3.95), p<0.001); previous HM (2.47 (1.33 to 4.62), p<0.001); and repeat PD 1-3 (1.58 (1.15 to 2.16), p=0.005), >3 (1.97 (1.21 to 3.19), p=0.006). Durability of up to 3 PD and HM over 10 years of follow-up was 86.2% and 81.9%, respectively (p<0.001).

DISCUSSION:

The efficacy of PD for achalasia appears to be greater than HM over 10 years. There was no mortality associated with HM, but 1.9% of subjects died within 30 days of PD. Mortality was associated with increasing age, comorbidity, previous HM and repeat PD.

 
 
Question posée
 
Quels sont les résultats à long terme (10 ans) de la dilatation pneumatique (jusqu’à 3 séances) et de la myotomie de Heller pour le traitement de l’achalasie ?
 
Question posée
 
Dans cette étude effectuée chez près de 7000 patients au Royaume-Uni, la dilatation pneumatique avait des résultats à 10 ans un peu supérieurs à la myotomie de Heller (86.2% vs 81.9%, p<0.001). La mortalité à 30j après dilatation pneumatique était de 5,3% chez les patients âgés de plus de 77ans et de 0,3% pour ceux âgés de moins de 65 ans. Elle était de 0% après chirurgie de Heller.
 
Commentaires

Une étude très solide sur les bénéfices à long terme des deux principaux traitements de l’achalasie. Il reste à mieux préciser le devenir des patients après POEM pour déterminer la place de ce dernier dans la prise en charge des patients avec achalasie.

 
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