Background A circular muscle myotomy preserving the longitudinal outer esophageal muscular layer is often recommended during peroral endoscopic myotomy (POEM) for achalasia. However, because the ...longitudinal muscle fibers of the esophagus are extremely thin and fragile, and completeness of myotomy is the basis for the excellent results of conventional surgical myotomy, this modification needs to be further debated. Here, we retrospectively analyzed our prospectively maintained POEM database to compare the outcomes of endoscopic full-thickness and circular muscle myotomy. Study Design According to the myotomy depth, 103 patients with full-thickness myotomy were assigned to group A, while 131 patients with circular muscle myotomy were assigned to group B. Symptom relief, procedure-related parameters and adverse events, manometry outcomes, and reflux complications were compared between groups. Results The mean operation times were significantly shorter in group A compared with group B (p = 0.02). There was no increase in any procedure-related adverse event after full-thickness myotomy (all p < 0.05). During follow-up, treatment success (Eckardt score ≤ 3) persisted for 96.0% (95 of 99) of patients in group A and for 95.0% (115 of 121) of patients in group B (p = 0.75). There were no statistically significant differences in pre- and post-treatment D-value of symptom scores and lower esophageal sphincter pressures between groups (both p > 0.05). The overall clinical reflux complication rates were also similar (21.2% vs 16.5%, p = 0.38). Conclusions Short-term symptom relief and manometry outcomes of each method were comparable. Full-thickness myotomy significantly reduced the procedure time but did not increase the procedure-related adverse events or clinical reflux complications.
Background Peroral endoscopic myotomy (POEM) has been developed to provide a less-invasive myotomy for achalasia in adults but seldom has been used in pediatric patients. Objective To evaluate the ...feasibility, safety, and efficacy of POEM for pediatric patients with achalasia. Design Single-center, prospective study. Setting Academic medical center. Patients A total of 27 pediatric patients (mean age 13.8 years, range 6-17 years) with achalasia. Interventions POEM. Main Outcome Measurements The primary outcome was symptom relief during follow-up, defined as an Eckardt score of ≤3. Secondary outcomes were procedure-related adverse events, clinical reflux adverse events, and lower esophageal sphincter (LES) pressure on manometry before and after POEM. Results A total of 26 cases (96.3%) underwent successful POEM. A submucosal tunnelling attempt failed in 1 case because of serious inflammation and adhesion. No serious adverse events related to POEM were encountered. During a mean follow-up period of 24.6 months (range 15-38 months), treatment success was achieved in all patients (mean score before vs after treatment 8.3 vs 0.7; P < .001). Mean LES pressure also decreased from a mean of 31.6 mm Hg to 12.9 mm Hg after POEM ( P < .001). Five patients developed clinical reflux adverse events (19.2%). Limitations Single center and lack of some objective evaluations. Conclusion This relatively long-term follow-up study adds to the evidence that POEM seems to be a promising new treatment for pediatric patients with achalasia, resulting in long-term symptom relief in all cases and without serious adverse events.
Background Peroral endoscopic myotomy (POEM) is a promising new endoscopic method for the treatment of achalasia. Objective The aim of this study was to analyze the value of routine postoperative CT ...of the chest to detect POEM-associated adverse events. Design Single-center, retrospective study. Setting Tertiary care center. Patients and Interventions Between August 2010 and July 2012, 428 patients underwent POEM. Three hundred postprocedure CT POEM patients were retrospectively analyzed and findings correlated with clinical outcome and management. Main Outcome Measurements The frequency of postoperative pathological CT scan findings after POEM and the rate of interventions required for adverse event management. Results The main CT findings could be divided into frequent and reversible sequelae of POEM, pneumomediastinum (48%), pneumoperitoneum (37%), and subcutaneous emphysema (28%), and into potential adverse events such as pneumothorax (17%), pleural effusion (66%), pneumonitis (52%), and focal atelectasis (21%). Only 17 of 50 patients with pneumothorax (5.6% of all patients) and 2 of 200 patients with pleural effusion (0.7% of all patients) required interventional treatment based on clinical symptoms. In 1 patient, a hematoma was observed on a CT scan before any clinical manifestation occurred. Increasing age and the use of air instead of CO2 were associated with an increased rate of pneumothorax ( P = .031; 95% confidence interval, 1.002-1.049 and P < .001; 95% confidence interval, 0.012-0.157, respectively). Limitations Single-center, retrospective study. Conclusions Routine chest CT scan for achalasia patients undergoing POEM is probably not warranted because of the high rate of minor and clinically irrelevant findings. The use of CO2 is obligatory to reduce related adverse events.
How to manage an endoscopy unit during a COVID-19 pandemic Liu, Xin-Yang; Cai, Ming-Yan; Wang, Ping ...
VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy,
06/2020, Letnik:
5, Številka:
6
Journal Article
Two sets of cross-sectional surveys were conducted among the general public and live poultry traders (LPTs) during January-February, 2014, to monitor attitudes toward human cases of avian influenza ...A(H7N9)-related control measures among these 2 parties in Guangzhou, China. We found generally high support for regular market rest days among the general public and LPTs, but only limited support for permanent central slaughtering of poultry. LPTs' support for relevant control measures declined after the citywide wet market closure.
Both selenium (Se) and melatonin reduce cadmium (Cd) uptake and mitigate Cd toxicity in plants. However, the relationship between Se and melatonin in Cd detoxification remains unclear. In this study, ...we investigated the influence of three forms of Se (selenocysteine, sodium selenite, and sodium selenate) on the biosynthesis of melatonin and the tolerance against Cd in tomato plants. Pretreatment with different forms of Se significantly induced the biosynthesis of melatonin and its precursors (tryptophan, tryptamine, and serotonin); selenocysteine had the most marked effect on melatonin biosynthesis. Furthermore, Se and melatonin supplements significantly increased plant Cd tolerance as evidenced by decreased growth inhibition, photoinhibition, and electrolyte leakage (EL). Se‐induced Cd tolerance was compromised in melatonin‐deficient plants following tryptophan decarboxylase (TDC) gene silencing. Se treatment increased the levels of glutathione (GSH) and phytochelatins (PCs), as well as the expression of GSH and PC biosynthetic genes in nonsilenced plants, but the effects of Se were compromised in TDC‐silenced plants under Cd stress. In addition, Se and melatonin supplements reduced Cd content in leaves of nonsilenced plants, but Se‐induced reduction in Cd content was compromised in leaves of TDC‐silenced plants. Taken together, our results indicate that melatonin is involved in Se‐induced Cd tolerance via the regulation of Cd detoxification.
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