Efficacité de la myotomie endoscopique dans les troubles moteurs de l’oesophage non achalasiques : une étude cas-témoin

Abstract : Introduction: per oral endoscopic myotomy or POEM is a new technic effective in achalasia, but needs more research in other esophageal motility disorders. The objective of the study was to evaluate clinical efficacy of POEM in non-achalasia esophageal motility disorders. Patients and method: a retrospective, multicentric case-control study was conducted in five French centers. Patients had to have to a non- achalasia esophageal motility disorder (NAEMD) diagnosed by high resolution manometry. In each case, two controls were matched: one patient with achalasia type I or II and one patient with achalasia type III. They were paired based on their age and sex. Clinical efficacy was judge by Eckardt score at 3 month, which it had to be equal or under 3. A high-resolution manometry was also done 3 months after the intervention. Results: a total of 90 patients (mean age 66, 57 men) were included in the study, 30 patients with achalasia type I-II, 30 patients with achalasia type III, and 30 patients with NAEMD (13 jackhammer esophagus, 6 spastic esophageal disorders, 4 nutcracker esophagus, and 7 esophageal junction obstruction). At the three-month mark, response rates were at 80 % (24/30) in NAEMD group, 90 % (27/30) in achalasia type I-II group and 100% (30/30) in achalasia type III group (p<0.01). We didn’t find à predictive factor of treatment response. In each group there was a significant improvement in term of symptoms of dysphagia, regurgitation and chest pain, with the exception of pain in achalasia group I-II where no significant improvement was observed. Post-operative complications rate was 12%. One mediastinitis was treated by drugs. The average duration of hospitalization was less than 5 days. No patient died during the study. Gastro-esophageal reflux rate was at 26% at the three-month mark. Conclusion: POEM is an efficacy treatment for non-achalasia esophageal motility disorders, even if response rates at short term are lower than those obtained in achalasia, particularly in achalasia type III.
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Master Thesis
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Lucie Bernardot. Efficacité de la myotomie endoscopique dans les troubles moteurs de l’oesophage non achalasiques : une étude cas-témoin. Médecine humaine et pathologie. 2018. ⟨dumas-02088980⟩

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