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Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia

Backgrounds and study aims  Treatment of octogenarian patients with achalasia with conventional treatments is effective but with compromised safety. Biodegradable stents (BS) are promising. We aimed to evaluate their safety, efficacy and clinical outcomes at early, mid and long-term in this populati...

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Autores principales: Hernandez-Mondragon, Oscar, Contreras, Luis Garcia, Pineda, Omar Michel, Blanco-Velasco, Geraro, Murcio-Pérez, Enrique
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2021
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159585/
https://www.ncbi.nlm.nih.gov/pubmed/34079856
http://dx.doi.org/10.1055/a-1386-3214
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author Hernandez-Mondragon, Oscar
Contreras, Luis Garcia
Pineda, Omar Michel
Blanco-Velasco, Geraro
Murcio-Pérez, Enrique
author_facet Hernandez-Mondragon, Oscar
Contreras, Luis Garcia
Pineda, Omar Michel
Blanco-Velasco, Geraro
Murcio-Pérez, Enrique
author_sort Hernandez-Mondragon, Oscar
collection PubMed
description Backgrounds and study aims  Treatment of octogenarian patients with achalasia with conventional treatments is effective but with compromised safety. Biodegradable stents (BS) are promising. We aimed to evaluate their safety, efficacy and clinical outcomes at early, mid and long-term in this population. Patients and methods  Naïve or previously-treated achalasic octogenarian patients underwent to BS placement (BSP) between December, 2010 and November, 2011, and were followed-up for 9-years. A strict follow-up was performed. Results  Thirty-two patients were included, (17 men [53.1 %]; median age 82 years [78–92]). BSP was performed in all patients. At 9y, 18/32 (56.2 %) completed protocol. Mean BSP time was 37.5±12.1 min and 34.4 % presented thoracic pain. At 1 m, six BS were migrated (18.7 %), requiring a second BSP fixed with hemoclips. At 3 m, twenty-three (72.8 %) completed degradation process. At 6 m, eighteen (56.2 %) presented clinical dysphagia, of whom 5/32 (15.6 %) presented stenotic-tissue hyperplasia, responding to balloon dilation in all cases. Pre-BSP Eckardt, Timed barium esophagram and integrated relaxation pressure improved post-BSP 6 m values (9 vs 2, p = 0.001; < 50 % = 93.8 % vs > 80 % = 81.5 %, p = 0.003 and 18.8 ± 3.2 vs 11.1 ± 2.6 mmHg, p = 0.001, respectively), and there were no significant changes up to 9y post-BSP. Esophagitis grade A or B was presented between 4.7 % to 11.2 % and controlled with PPI. After 9 years we had clinical success rates of 94.4 %, 72 %, and 65.4 % for time point evaluation, per protocol and intention to treat analysis, respectively. Conclusions  BSP represents a feasible alternative option in octogenarian patients with achalasia who are high risk with other treatments, presenting acceptable early, mid-, and long-term outcomes.
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spelling pubmed-81595852021-06-01 Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia Hernandez-Mondragon, Oscar Contreras, Luis Garcia Pineda, Omar Michel Blanco-Velasco, Geraro Murcio-Pérez, Enrique Endosc Int Open Backgrounds and study aims  Treatment of octogenarian patients with achalasia with conventional treatments is effective but with compromised safety. Biodegradable stents (BS) are promising. We aimed to evaluate their safety, efficacy and clinical outcomes at early, mid and long-term in this population. Patients and methods  Naïve or previously-treated achalasic octogenarian patients underwent to BS placement (BSP) between December, 2010 and November, 2011, and were followed-up for 9-years. A strict follow-up was performed. Results  Thirty-two patients were included, (17 men [53.1 %]; median age 82 years [78–92]). BSP was performed in all patients. At 9y, 18/32 (56.2 %) completed protocol. Mean BSP time was 37.5±12.1 min and 34.4 % presented thoracic pain. At 1 m, six BS were migrated (18.7 %), requiring a second BSP fixed with hemoclips. At 3 m, twenty-three (72.8 %) completed degradation process. At 6 m, eighteen (56.2 %) presented clinical dysphagia, of whom 5/32 (15.6 %) presented stenotic-tissue hyperplasia, responding to balloon dilation in all cases. Pre-BSP Eckardt, Timed barium esophagram and integrated relaxation pressure improved post-BSP 6 m values (9 vs 2, p = 0.001; < 50 % = 93.8 % vs > 80 % = 81.5 %, p = 0.003 and 18.8 ± 3.2 vs 11.1 ± 2.6 mmHg, p = 0.001, respectively), and there were no significant changes up to 9y post-BSP. Esophagitis grade A or B was presented between 4.7 % to 11.2 % and controlled with PPI. After 9 years we had clinical success rates of 94.4 %, 72 %, and 65.4 % for time point evaluation, per protocol and intention to treat analysis, respectively. Conclusions  BSP represents a feasible alternative option in octogenarian patients with achalasia who are high risk with other treatments, presenting acceptable early, mid-, and long-term outcomes. Georg Thieme Verlag KG 2021-06 2021-05-27 /pmc/articles/PMC8159585/ /pubmed/34079856 http://dx.doi.org/10.1055/a-1386-3214 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Hernandez-Mondragon, Oscar
Contreras, Luis Garcia
Pineda, Omar Michel
Blanco-Velasco, Geraro
Murcio-Pérez, Enrique
Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia
title Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia
title_full Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia
title_fullStr Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia
title_full_unstemmed Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia
title_short Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia
title_sort safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159585/
https://www.ncbi.nlm.nih.gov/pubmed/34079856
http://dx.doi.org/10.1055/a-1386-3214
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