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Su1093 “Esophageal Remodeling” After Peroral Endoscopic Myotomy in Achalasia
Su1093
Background: Peroral endoscopic myotomy (POEM) is a new efficacious treatment option for achalasia. We propose to denominate "esophageal remodeling" as functional restorations of esophagus with not only the decrease in LES pressure but also with the decrease in diameter and recovery of peristalsis of esophageal body. The aim of this study was to investigate the "esophageal remodeling" after POEM in achalasia. Methods: We performed POEM from July 2013, and prospectively collected data of preoperative and postoperative 2-month Eckardt symptom score, esophageal high resolution manometry (HRM) and/or timed barium esophagogram (TBE). From July 2013 to September 2015, 27 patients with achalasia underwent POEM in our institution, and among them, we analyzed 18 patients (10 male; mean age: 53.6 years; 5 type I, 8 type II, 5 type III) whose HRM and TBE were available both in preoperative and postoperative stage. Results: All patients achieved treatment success (Eckardt score£3). Partial recovery of body peristalsis was encountered in 2 patients with type I (40%), 5 with type II (62.5%), and 4 with type III (80%) achalasia after POEM. Among them, 2 of 5 patients with type III (40%) achalasia showed almost full recovery of body peristalsis after POEM. Panesophageal pressurization disappeared after POEM in 7 of 8 type II achalasia patients. In the 2 patients whose post-POEM integrated relaxation pressure was more than 15mmHg, one showed absent peristalsis and the other showed premature contraction in postoperative HRM. The average diameter of esophageal body after POEM was significantly decreased in all types of achalasia. Conclusions: POEM resulted in excellent symptomatic success. Also, POEM decreased the diameter of esophageal body and restored peristalsis of body in a considerable number of patients. Thus, we conclude that POEM provides not only excellent clinical symptomatic success, but also esophageal remodeling in terms of restoration of peristalsis and diameter of esophageal body, especially in type III achalasia.
Su1094 EGJ Outflow Obstruction and Minor Motility Disorders Are Common in Diabetic Patients With Esophageal Symptoms Nina George, Vikram V. Rangan, Zhuo Geng, Freeha Khan, Rosita D. Frazier, Scott L. Gabbard, Stephen J. Ganocy, Ronnie Fass Introduction: Diabetes mellitus affects more than 29 million people in the US, and approximately 15% of diabetic patients have esophageal symptoms that in many cases warrant evaluation with high resolution esophageal manometry. However, there is a paucity of information describing the features of esophageal manometry in diabetic patients. The aim of this study was to determine the clinical characteristics and manometric findings of symptomatic diabetic patients as compared with non-diabetic patients. Methods: A nested case controlled study was performed, using esophageal manometry data sets from two major medical centers. A total of 292 patients were included in the final analysis. Patient's age, sex, history of diabetes, medication use, prior upper endoscopy reports and esophageal manometry results were recorded in a single registry. Results: Of the 292 patients, 70% were female, 60% Caucasian and 43% diabetic. Among all patients undergoing manometry, patients with major disorders of motility (absent contractility, distal esophageal spasm, and jackhammer esophagus) tended to be older compared to patients with normal motility (63.92 ± 10.49 years vs 57.74 ± 10.53 years, P value < 0.01). Of the diabetic patients, 48% had an esophageal motor disorder, and of those, 57.3% had a minor motor disorder (54.1% with ineffective esophageal motility and 3.2% with fragmented peristalsis), 16.4% primary EGJ outflow obstruction, 14.7% Achalasia (4.9% with Achalasia type 1 and 9.8% with Achalasia type 2), and 11.5% with major motility disorders (4.9% absent contractility, 3.3% distal esophageal spasm, and 3.3% jackhammer esophagus). Diabetic patients were more likely to have an abnormal manometry (48% vs 42%) and more likely to have primary EGJ outflow obstruction (7.9% vs 2.4%, p=0.029). Use of opiates, proton pump inhibitors, muscle relaxants, calcium channel blockers, nitrates, level of hemoglobin A1c, and history of gastroparesis did not predict any particular esophageal motor disorder in diabetic patients. Discussion: About half of the diabetic patients with esophageal related symptoms demonstrate an esophageal motor disorder. Minor motor disorder is the most common diagnosis. EGJ outflow obstruction appears to be more common in diabetic patients as compared to controls. Table 1
Su1092 Role of Achalasia Subtype in Radiographic Bird-Beak Narrowing of the Gastroesophageal Junction Eugenie Shieh, Ellen M. Stein, John O. Clarke, Monica Nandwani, Sameer Dhalla Context: The classic radiographic finding of "bird-beak" narrowing of the gastroesophageal junction supports the diagnosis of achalasia. Achalasia is classified into subgroups based on manometric phenotype. The association of achalasia subtype with a radiographic bird-beak appearance is unclear. Objective: To evaluate the association of subtype with the radiographic bird-beak appearance of the gastroesophageal junction in patients with achalasia. Design. Retrospective cohort study from June 2008 to October 2012. Setting. Inpatients and outpatients from Johns Hopkins Hospital Patients. 84 patients with a diagnosis of achalasia who underwent both barium esophagram and high-resolution esophageal manometry (HREM) Main Outcome Measure. The outcome measure is the odds ratio for association between subtype and the radiographic finding of bird-beak narrowing in patients with achalasia, adjusted for age. Results. 84 patients with manometrically diagnosed achalasia underwent both barium esophagram and HREM during the study period. No association was observed between achalasia subtype I and II (OR 3.17, 95% CI 0.60-16.8, p=0.18) or between I and III (OR 2.07, 95% CI 0.20-21.2, p=0.54) and the radiographic finding of bird-beak narrowing of the gastroesophageal junction. Conclusion. Achalasia subtype does not appear to be associated with the radiographic finding of bird-beak narrowing of the gastroesophageal junction. Table. Results of Simple Logistic Regression and Multiple Logistic Regression with Birdbeak Narrowing of the Gastroesophageal Junction
Abbreviations: CI, Confidence Interval. Define reference group for race and subtype *Age as a continuous variable with 2 linear splines with knots at age 40 and 70. **Reference group, white. ***Reference group, subtype I
S-467
AGA Abstracts
AGA Abstracts
"Esophageal Remodeling" After Peroral Endoscopic Myotomy in Achalasia Cheal Wung Huh, Hyunsoo Chung, Young Hoon Youn, Yong Chan Lee, Hyojin Park
Background: Peroral endoscopic myotomy (POEM) is a new efficacious treatment option for achalasia. We propose to denominate "esophageal remodeling" as functional restorations of esophagus with not only the decrease in LES pressure but also with the decrease in diameter and recovery of peristalsis of esophageal body. The aim of this study was to investigate the "esophageal remodeling" after POEM in achalasia. Methods: We performed POEM from July 2013, and prospectively collected data of preoperative and postoperative 2-month Eckardt symptom score, esophageal high resolution manometry (HRM) and/or timed barium esophagogram (TBE). From July 2013 to September 2015, 27 patients with achalasia underwent POEM in our institution, and among them, we analyzed 18 patients (10 male; mean age: 53.6 years; 5 type I, 8 type II, 5 type III) whose HRM and TBE were available both in preoperative and postoperative stage. Results: All patients achieved treatment success (Eckardt score£3). Partial recovery of body peristalsis was encountered in 2 patients with type I (40%), 5 with type II (62.5%), and 4 with type III (80%) achalasia after POEM. Among them, 2 of 5 patients with type III (40%) achalasia showed almost full recovery of body peristalsis after POEM. Panesophageal pressurization disappeared after POEM in 7 of 8 type II achalasia patients. In the 2 patients whose post-POEM integrated relaxation pressure was more than 15mmHg, one showed absent peristalsis and the other showed premature contraction in postoperative HRM. The average diameter of esophageal body after POEM was significantly decreased in all types of achalasia. Conclusions: POEM resulted in excellent symptomatic success. Also, POEM decreased the diameter of esophageal body and restored peristalsis of body in a considerable number of patients. Thus, we conclude that POEM provides not only excellent clinical symptomatic success, but also esophageal remodeling in terms of restoration of peristalsis and diameter of esophageal body, especially in type III achalasia.
Su1094 EGJ Outflow Obstruction and Minor Motility Disorders Are Common in Diabetic Patients With Esophageal Symptoms Nina George, Vikram V. Rangan, Zhuo Geng, Freeha Khan, Rosita D. Frazier, Scott L. Gabbard, Stephen J. Ganocy, Ronnie Fass Introduction: Diabetes mellitus affects more than 29 million people in the US, and approximately 15% of diabetic patients have esophageal symptoms that in many cases warrant evaluation with high resolution esophageal manometry. However, there is a paucity of information describing the features of esophageal manometry in diabetic patients. The aim of this study was to determine the clinical characteristics and manometric findings of symptomatic diabetic patients as compared with non-diabetic patients. Methods: A nested case controlled study was performed, using esophageal manometry data sets from two major medical centers. A total of 292 patients were included in the final analysis. Patient's age, sex, history of diabetes, medication use, prior upper endoscopy reports and esophageal manometry results were recorded in a single registry. Results: Of the 292 patients, 70% were female, 60% Caucasian and 43% diabetic. Among all patients undergoing manometry, patients with major disorders of motility (absent contractility, distal esophageal spasm, and jackhammer esophagus) tended to be older compared to patients with normal motility (63.92 ± 10.49 years vs 57.74 ± 10.53 years, P value < 0.01). Of the diabetic patients, 48% had an esophageal motor disorder, and of those, 57.3% had a minor motor disorder (54.1% with ineffective esophageal motility and 3.2% with fragmented peristalsis), 16.4% primary EGJ outflow obstruction, 14.7% Achalasia (4.9% with Achalasia type 1 and 9.8% with Achalasia type 2), and 11.5% with major motility disorders (4.9% absent contractility, 3.3% distal esophageal spasm, and 3.3% jackhammer esophagus). Diabetic patients were more likely to have an abnormal manometry (48% vs 42%) and more likely to have primary EGJ outflow obstruction (7.9% vs 2.4%, p=0.029). Use of opiates, proton pump inhibitors, muscle relaxants, calcium channel blockers, nitrates, level of hemoglobin A1c, and history of gastroparesis did not predict any particular esophageal motor disorder in diabetic patients. Discussion: About half of the diabetic patients with esophageal related symptoms demonstrate an esophageal motor disorder. Minor motor disorder is the most common diagnosis. EGJ outflow obstruction appears to be more common in diabetic patients as compared to controls. Table 1
Su1092 Role of Achalasia Subtype in Radiographic Bird-Beak Narrowing of the Gastroesophageal Junction Eugenie Shieh, Ellen M. Stein, John O. Clarke, Monica Nandwani, Sameer Dhalla Context: The classic radiographic finding of "bird-beak" narrowing of the gastroesophageal junction supports the diagnosis of achalasia. Achalasia is classified into subgroups based on manometric phenotype. The association of achalasia subtype with a radiographic bird-beak appearance is unclear. Objective: To evaluate the association of subtype with the radiographic bird-beak appearance of the gastroesophageal junction in patients with achalasia. Design. Retrospective cohort study from June 2008 to October 2012. Setting. Inpatients and outpatients from Johns Hopkins Hospital Patients. 84 patients with a diagnosis of achalasia who underwent both barium esophagram and high-resolution esophageal manometry (HREM) Main Outcome Measure. The outcome measure is the odds ratio for association between subtype and the radiographic finding of bird-beak narrowing in patients with achalasia, adjusted for age. Results. 84 patients with manometrically diagnosed achalasia underwent both barium esophagram and HREM during the study period. No association was observed between achalasia subtype I and II (OR 3.17, 95% CI 0.60-16.8, p=0.18) or between I and III (OR 2.07, 95% CI 0.20-21.2, p=0.54) and the radiographic finding of bird-beak narrowing of the gastroesophageal junction. Conclusion. Achalasia subtype does not appear to be associated with the radiographic finding of bird-beak narrowing of the gastroesophageal junction. Table. Results of Simple Logistic Regression and Multiple Logistic Regression with Birdbeak Narrowing of the Gastroesophageal Junction
Abbreviations: CI, Confidence Interval. Define reference group for race and subtype *Age as a continuous variable with 2 linear splines with knots at age 40 and 70. **Reference group, white. ***Reference group, subtype I
S-467
AGA Abstracts
AGA Abstracts
"Esophageal Remodeling" After Peroral Endoscopic Myotomy in Achalasia Cheal Wung Huh, Hyunsoo Chung, Young Hoon Youn, Yong Chan Lee, Hyojin Park