Peroral endoscopic myotomy: a two-center retrospective study of practice and adverse events

Background and study aims

Peroral endoscopic myotomy (POEM) is the preferred technique for the treatment of esophageal motility disorders and is less invasive than surgery. This study was performed to compare two university centers in the practice of POEM, in terms of efficacy and adverse events, for the treatment of esophageal motility disorder.

Patients and methods

Retrospective comparative study of patients undergoing a POEM between September 2020 and December 2022 from the University Hospital of Liège (Belgium) and Besançon (France). The clinical success was defined by an Eckardt score ≤ 3 after the procedure.

Results

Fifty-five patients were included. In both centers, 87,3% of the patients had achalasia (mostly type II), and 12,7% had another esophageal motility disorder. The use of antibiotic prophylaxis was systematic in Liège center but not in Besançon center (100% and 9.1% respectively). The mean value of the post-operative Eckardt score was 1.55± 2.48 in both center with 93.2% of patients with a score ≤ 3 (92% in Besançon and 94.74% in Liège). The rate of adverse event was generally low. There were two minor adverse events more frequent in Liège, clinical capnomediastinum and pain at day one, but they were managed with conservative treatment. Only 7.3% of the total patients had an infectious phenomenon that did not correlate with the use of antibiotic prophylaxis.

Conclusion

The post-operative Eckardt score and the adverse event rate were comparable between the university centers. This study confirmed that POEM is a safe and effective technique. It also showed that using an antibiotic prophylaxis does not influence the development of infectious adverse events.

[Liver hydatidosis causing obstructive cholangitis : a case report]

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[Pre-malignant and malignant diseases of the esophagus, a centralized and multidisciplinary approach]

Esophageal cancer is the 19th most common cancer in the European Union. Its prognosis remains poor with a 5-year survival rate estimated between 15 % and 25 %. Accurate diagnosis and pre-therapeutic assessment are essential and should allow a rapid start of therapy. Current treatment is based on multimodal management of which surgery remains the cornerstone. Since 2019, Belgium has started an agreement to centralize esophageal surgery in order to improve surgical outcomes. One year after implementation of centralization, our centre shows a low rate of severe complications (Clavien-Dindo classification IIIb-V) of 20 % and a 0 % mortality rate at 30 and 90 postoperative days. Our patients have benefited from a full minimally invasive or hybrid surgical procedure, contributing to those positive results. In the future, all our efforts must be done to improve collaboration between hospitals in order to provide best medical and surgical treatments.

[Increased neoplastic risks in ulcerative colitis associated with primary sclerosing cholangitis]

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[The diagnostic trap of acute pancreatitis with normal pancreatic enzymes]

We report the case of a patient admitted in Emergency Care for abdominal pain and whose biological assessment did not show any increase in pancreatic enzymes. The abdominal CT-scan revealed pancreatitis of grade E according to the Balthazar radiological score. A diagnosis of acute necrotic pancreatitis secondary to hypertriglyceridemia was thus made. In cases of acute pancreatitis, the rate of pancreatic enzymes may rarely be normal for unclear reasons. In the case of an evocative clinical presentation, the diagnosis of acute pancreatitis cannot be ruled out on the basis of this normal dosage. A CT-scan of the pancreas is then indicated to confirm the diagnosis.

[Alcool and pancreatic complications]

Alcohol consumption is the main cause of development of chronic pancreatitis and the second etiology of acute pancreatitis. The mortality of acute pancreatitis depends on its necrotic haemorrhagic character and the initial inflammatory response, while pain, malnutrition and diabetes are the main issues in the management of chronic pancreatitis. As medical and endoscopic techniques progress, surgical indications have become increasingly rare but remain indispensable for some patients. The multidisciplinary approach of these patients is the key to the success of care.

[RENDU-OSLER DISEASE: A RARE CAUSE OF AMMONIA ENCEPHALOPATHY]

Hereditary Hemorrhagic Telangiectasia (HHT) also known as Rendu-Osler disease is a group of related disorders inherited in an autosomal dominant fashion and characterized by the development of arteriovenous malformations (AVM) in the skin, mucous membranes, and/or internal organs such as the brain, lungs, and liver. The prevalence of liver involvement is clinically estimated between 8 and 31 percent. It can be revealed by the following clinical signs : ascites, edema of the lower extremities, abdominal pain, dyspnea, and, rarely, hepatic encephalopathy and gastrointestinal bleeding associated with portal hypertension. This case illustrates the highlight of liver damage revealed by an ammonia encephalopathy associated with iconographic anomalies on ultrasonography and magnetic resonance liver as part of Rendu-Osler disease.