Background
Peroral esophageal myotomy (POEM) is a new endoscopic operation for the treatment of achalasia. Here, we report 1-year physiologic and symptomatic outcomes following the procedure.
Methods
...POEM patients from a single-institution series who were more than 1 year removed from surgery were studied. Eckardt and GerdQ scores were obtained to assess symptoms. High-resolution manometry (HRM), timed barium esophagram (TBE), and upper endoscopy were preformed preoperatively and at 1-year follow-up. 24-h pH monitoring was also performed at 1 year follow-up.
Results
The study population was comprised of 41 patients who were more than 1 year post-POEM. One (2 %) major complication, a contained leak at the EGJ requiring re-operation, and 7 (17 %) minor complications occurred. Mean length of stay was 1.4 days. At mean 15-month follow-up, Eckardt scores improved from pre-POEM 7 ± 2 to post-POEM 1 ± 2, (scale 0–12,
p
< .001), and 92 % of patients achieved treatment success (Eckardt score <4). Two of the three treatment failures in the series occurred in the initial three patients. 15 % of patients had post-POEM symptoms suggestive of gastroesophageal reflux (GerdQ >7). On follow-up HRM, esophagogastric junction integrated relaxation pressure was decreased significantly (pre-POEM 28 ± 12 mmHg vs. post-POEM 11 ± 4 mmHg,
p
< .001), and 47 % of patients studied had partial recovery of peristalsis. On follow-up TBE, barium column heights were decreased compared with preoperatively. Postoperative upper endoscopy revealed esophagitis in 59 % of patients (11 LA Grade A, 2 LA Grade D). However, of the 13 24-h pH monitoring studies performed, only four (31 %) demonstrated pathologic esophageal acid exposure.
Conclusions
In this series, POEM resulted in greater than 90 % symptomatic treatment success at mean 15-month follow-up. Rates of iatrogenic gastroesophageal reflux, as measured both by symptoms and 24-h pH monitoring, appeared to be on par with recent studies of patients undergoing laparoscopic Heller myotomy and pneumatic dilation.
Background
Numerous studies show changes in functional lumen imaging probe (FLIP) measurements after myotomy during peroral endoscopic myotomy (POEM), but few report on FLIP measurements at follow-up ...esophagogastroduodenoscopy (EGD). The purpose of this study was to compare perioperative FLIP measurements to those at follow-up EGD.
Methods
Patients who underwent POEM with FLIP in the operating room and POEM patients who had EGD with FLIP at follow-up were included. FLIP measurements, including diameter (Dmin), pressure, cross-sectional area (CSA), and distensibility index (DI), were analyzed at a 30-mL balloon fill. Differences between measurements at different timepoints were assessed using a two-tailed Wilcoxon signed-rank test.
Results
A total of 97 patients who underwent POEM and 28 who underwent EGD with FLIP were analyzed. The average age was 63 ± 18 years and 46.4% of the patients were male. Mean preoperative Eckardt score was 6.5 ± 4.8, decreasing to 1.6 ± 2.0 at follow-up. EGDs were performed at a median of 15 months after surgery. When compared to mean measurements obtained post-myotomy, at the time of EGD, pressure was found to be significantly lower (
p
= 0.007) and DI significantly higher (
p
= 0.045). Of the patients who underwent EGD, 70.8% had an increase in DI, 55.6% had evidence of reflux esophagitis, and 81.0% met diagnostic criteria for reflux on esophageal pH monitoring. However, there was no correlation with the development of esophagitis or reflux and increase or decrease in DI at follow-up.
Conclusions
There are significant changes in FLIP measurements between the time of surgery and at follow-up EGD. These results suggest that esophageal remodeling may cause changes in lower esophageal sphincter geometry after POEM and postoperative FLIP targets immediately post-myotomy may need to be adjusted to account for these changes.
The difficult position of Bosniaks Sandžak at the beginning of the 20th century has caused the uprising of individuals from the authorities and their association with comites (rebels). According to ...historical sources, the most famous Sandzak rebel was Jusuf Mehonjić, a native of Šahović (village Grančarevo), which Zaimović, in one of his work, called the Bosniak's Wilhelm Tell. He is mentioned in numerous epic poems called the so-called rebel opus that we find in the collections of oral literature of Bosniaks Sandžak, and from them the knowledge of his intellectual and physical potential, as well as the character of the protector of the disadvantaged and endangered Bosniaks. However, when it comes to ethnomusicological collections, we find that there is not a single song about this historical personality in them. The aim of this work is to preserve the musical tradition of Sandzak Bosniaks by finding and ethnomusicologic recording of lyrical poems about Jusuf Mehonjic, as well as pointing to the possibility of their nurturing through the education system in teaching in the Bosnian language in Serbia. The work and the work of Jusuf Mehonjić were examined in the paper by theoretical analysis of historical and literary sources. At the same time, the Finnish method recorded the only lyrical song about him, which we found by exploring the live musical tradition of the Sandzak Bosniaks. This is the song of Moj sokole pogledaj niz polje. This work should contribute to preserving the musical tradition of the Sandzak Bosniaks and getting to know Jusuf Mehonjic - a significant figure in the history of Sandzak.
The article deals with collection of poems by John Bunyan “The Book for Boys and Girls” (1686), which had the subtitle “The Country of Rhythmic Rows for Children”. In different editions it is known ...as “The Book for Boys and Girls: Divine Emblems or Temporal Things Spiritualised” (1724) and from XIXth cent. The title got the abbreviated form (“Divine Emblems or Temporal Things Spiritualised”). In ancient European literature, it is considered the first book of poems for children and today, it is not translated into Ukrainian or Russian. Meanwhile, this book is undeservedly forgotten not only in the national history of children's literature, but also in foreign literary criticism. The book is based on 49 emblems, accompanied by religious and moral lessons from everyday things. The Bunyan’s poems are written on the subjects of well-known emblems and contain the instructional and entertaining functions, as well as an appeal for self-knowledge and self-improvement, and were designed not only for the children's audience. The article presents a complete description of the emblems selected by Bunyan to express their ideological guidance with illustrative material.
Background
Achalasia is an uncommon disease treated by decreasing the lower esophageal sphincter resting pressure. This study compared the safety and efficacy of esophago-gastric myotomy via ...laparoscopic, robotic, and per-oral endoscopic approaches.
Methods
A retrospective review of data on patients with achalasia or other esophageal dysmotility disorder undergoing laparoscopic, robotically assisted, or per-oral endoscopic myotomy (POEM) procedures between 2013 and 2017 was performed. Patient demographics, comorbidities, procedure details, length of stay, 30-day readmission rate, and combined technical complication (full-thickness injury, conversion to open, and delayed perforation) were compared. Multiple logistic regression analysis was performed to determine which factors contributed to combined technical complication.
Results
There were 171 patients who underwent esophago-gastric myotomy with 161 (94.2%) having achalasia. There were 40 laparoscopic Heller myotomies with partial fundoplication, 44 robotic Heller myotomies with partial fundoplication, and 87 POEM procedures performed during the study period. Baseline statistical differences were found among the groups in regard to gastroesophageal reflux symptoms, arrhythmia, hypertension, and congestive heart failure. Laparoscopic Heller myotomy had significantly higher combined technical complications (7, 17.5%) compared to robotically assisted Heller myotomy (0, 0%) and POEM (1, 1.1%). Multivariate analysis showed that laparoscopic Heller myotomy (OR 32.22; 95% CI 2.66, 389.83;
p
= 0.01), myocardial infarction (OR 27.94; 95% CI 1.66, 471.10;
p
= 0.02), and history of smoking (OR 8.87; 95% CI 1.29, 61.15;
p
= 0.03) were risks for developing combined technical complications.
Conclusion
Robotically assisted Heller myotomy and POEM are safe and efficacious treatments for achalasia with lower rates of technical complications compared to laparoscopic Heller myotomy. With the advancements in endoscopic instruments and robotic surgery, POEM and robotically assisted Heller myotomy should be considered in the treatment of achalasia and esophageal dysmotility disorders.
En el presente artículo se examina la exposición y la construcción de algunos de los Poemas pintados de Vicente Huidobro que exhibió en París, en 1922, hecho que marca, en todo su despliegue de ...exposición artística, la relación provocadora entre poesía y pintura. De otro lado, se explora la producción de la poesía como objeto estético dinámico y móvil en 5 metros de poemas de Carlos Oquendo de Amat. Con el análisis de esta producción poética se propone establecer una comparación entre los poemas “Paisaje”, de Huidobro, y “Film del paisaje”, de Oquendo de Amat, para señalar cómo la necesidad del diseño y la dimensión gráfico-espacial de los poemas marcaron el espíritu vanguardista en América Latina, al mismo tiempo, esta necesidad llevó, a los dos poetas a concebir la poesía como producción material y estética más allá del soporte y formato tradicional del libro.
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