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, Serment d'Hippocrate

, Au moment d'être admis(e) à exercer la médecine, je promets et je jure d'être fidèle aux lois de l'honneur et de la probité

, Mon premier souci sera de rétablir, de préserver ou de promouvoir la santé dans tous ses éléments, physiques et mentaux

, Je respecterai toutes les personnes, leur autonomie et leur volonté, sans aucune discrimination selon leur état ou leurs convictions. J'interviendrai pour les protéger si elles sont affaiblies, vulnérables ou menacées dans leur intégrité ou leur dignité. Même sous la contrainte

, Je ne tromperai jamais leur confiance et n'exploiterai pas le pouvoir hérité des circonstances pour forcer les consciences

, Reçu(e) à l'intérieur des maisons, je respecterai les secrets des foyers et ma conduite ne servira pas à corrompre les moeurs

, Je ferai tout pour soulager les souffrances. Je ne prolongerai pas abusivement les agonies. Je ne provoquerai jamais la mort délibérément

, Je n'entreprendrai rien qui dépasse mes compétences. Je les entretiendrai et les perfectionnerai pour assurer au mieux les services qui me seront demandés

, J'apporterai mon aide à mes confrères ainsi qu'à leurs familles dans l'adversité

, Résumé : Introduction : La myotomie oesophagienne endoscopique ou POEM est une technique récente validée dans le cadre de l'achalasie de l'oesophage, mais reste encore à l'étude dans les autres troubles moteurs de l'oesophage. L'objectif de l'étude était d'évaluer l'efficacité clinique de la POEM chez des sujets atteints de troubles moteurs de l, Que les hommes et mes confrères m'accordent leur estime si je suis fidèle à mes promesses ; que je sois déshonoré(e) et méprisé(e) si j'y manque

. Patients, Pour chaque cas, étaient appariés deux témoins : un patient atteint d'achalasie de type I ou II et un patient atteint d'achalasie de type III. L'appariement se faisait sur le sexe et l'âge, à 10 ans près. L'efficacité clinique était jugée sur le score d'Eckardt à trois mois qui devait être inférieur ou égal à 3. Une manométrie haute résolution était également réalisée trois mois après l'intervention. Résultats : Un total de 90 patients (âge médian 66 ans, 57 hommes) a été inclus dans l'étude, 30 patients avec une achalasie de type I ou II, 30 patients avec une achalasie de type III et 30 avec un TMNA (13 oesophages marteau piqueur, 6 spasmes diffus de l'oesophage, 4 oesophages casse-noisette et 7 obstructions de la JOG). A 3 mois les taux de réponse étaient 80% (24/30) dans le groupe TMNA, 90% (27/30) dans le groupe achalasie type I-II et 100% (30/30) dans le groupe achalasie type III (p<0.01). Il n'existait pas de facteur prédictif de réponse au traitement. Dans, chacun des groupes on observait une amélioration significative des symptômes dysphagie, régurgitation et douleur thoracique, à l'exception de la douleur dans le groupe achalasie I-II où on n'observait pas d'amélioration significative. Le taux de complication post opératoire était de 12%. A noter une médiastinite traité médicalement, Une étude cas-témoin, rétrospective, multicentrique a été réalisée dans cinq centres français. Les patients inclus devaient présenter un trouble moteur non achalasique confirmé par manométrie haute résolution

, Conclusion : La POEM est un traitement efficace des troubles moteurs de l'oesophage non achalasiques, même si les taux de réponses à court terme sont inférieurs à ceux obtenus dans l'achalasie

, Titre en anglais: Efficacy of endoscopic myotomy in non-achalasia esophageal motility disorders: a case-control study, Discipline: Hépato-gastroentérologie

, Mots clés: POEM, troubles moteurs non achalasiques, achalasie, oesophage marteau piqueur, spasmes diffus de l'oesophage, manométrie oesophagienne haute résolution Service de Gastro-entérologie, Pr Zerbib, Hopital Haut Lévèque 33600 Pessac