The Struggle Goes On Africa, Sixteenth Century: While I tilled African soil so intimately familiar with my footsteps, digging stick, sweat and resting bones, Land that gave me sustenance (for ...generations, centuries and millennia) and unites my here and now with my yesterdays and my tomorrows, The man came. St Vincent, Eighteenth Century: An all but lifeless thing drifting in time and space, I and I chanced upon Yurumei, a new beginning and a new set of footsteps retraceable to the upper branches of the Amazon; Africa grafted upon Amerindian stock, I and I felt my roots grasp firm and deep Yurumei soil, whence drew I life and a new tomorrow. Glossary Ague: Africa Aginena: African Yurumei: St Vincent Yurumeina: Vincentian Balisi: Belize Balisina: Belizean E. ROY CAYETANO, now retired, worked for many years in the Belizean education system and served as permanent secretary/chief executive officer in several government ministries and in the senate.
Per oral endoscopic myotomy for achalasia de Sire, Roberto; Capogreco, Antonio; Massimi, Davide ...
Baillière's best practice & research. Clinical gastroenterology,
6/2024
Journal Article
Gastroparesis (GP) can be a severe and debilitating disease. Its pathophysiology is complex and not completely understood. Two principal mechanisms are responsible for the development of symptoms – ...gastric hypomotility and pylorospasm. Pylorus targeted therapies aim to decrease presumably elevated pyloric tone – pylorospasm. There is a growing body of evidence about their role in the treatment algorithm of GP. G-POEM (endoscopic pyloromyotomy) is an extensively studied pylorus targeted therapy. Its efficacy ranges between 56 and 80% and the number of recurrences among those with treatment effect seems low. G-POEM is a safe procedure with very low frequency of severe adverse events. At present, G-POEM should not be considered as an experimental approach and may be offered to all patients with refractory and severe GP. Nevertheless, G-POEM is not a first line treatment. Conservative measures such as diet modification and pharmacotherapy should always be tried before G-POEM is considered. Further research must focus on better patient selection as at present there are no standardized criteria. Functional imaging such as impedance planimetry (EndoFlip) may hold promise in this regard.
•POEM for achalasia: Selective myotomy targeting inner circular layer equals full thickness in efficacy.•Full thickness myotomy was associated with longer hospital stays and more pain relief use.•No ...significant difference in reflux rates between selective and full thickness myotomy.•Selective circular myotomy should be preferred over full thickness in POEM for achalasia.
The aim of this study was to compare the impact of the depth of myotomy (selective inner layer myotomy (SIM) vs. full-thickness myotomy (FTM)) on the outcome of patients treated with POEM for achalasia.
This was a retrospective, observational, conducted in two tertiary centers between October 2018 and September 2022. Patients were divided into two groups: SIM and FTM. The primary endpoint was clinical efficacy at 6 months, while secondary endpoints were postoperative criteria (such as pain, length of hospital stay, complications) and occurrence of gastroesophageal reflux disease (GERD) (esophagitis at 6 months, heartburn, and pH-metry).
158 patients were included in the study (33 in the FTM group and 125 in the SIM group). The success rates at 6 and 12 months were similar in both groups, with 84 % and 70 % in the SIM group versus 90 % and 80 % in the FTM group, respectively (p = 0.57 and p = 0.74). However, more opioid analgesics were consumed in the FTM group compared to the SIM group (41% vs 21 %, p < 0.01). The length of hospitalization was longer in the FTM group than in the SIM group (2.17 ± 2.62 vs 2.94 ± 2.33, p < 0.001). The rate of esophagitis at 6 months was comparable (16 % in the SIM group vs 12 % in the FTM group, p = 0.73). There was no significant difference in terms of heartburn at 6 or 12 months between the SIM and FTM groups (18.5% vs 3.8 %, p = 0.07 and 27% vs 12.5 %, p = 0.35, respectively).
There was no significant difference in terms of clinical efficacy and GERD occurrence between FTM and SIM. However, full-thickness myotomy was associated with more postoperative pain and a longer length of hospital stay. Therefore, selective internal myotomy should be preferred over full-thickness myotomy.
