Background/Objectives: Tacrine is a centrally active non-competitive reversible acetylcholinesterase inhibitor. It also exerts antagonising activity against N-methyl-D-aspartate receptors. Tacrine was approved for the treatment of Alzheimer's disease in 1993, but was withdrawn from clinical use in 2013 because of its hepatotoxicity and gastrointestinal side effects. Nevertheless, tacrine is currently facing a renewed wave of interest primarily due to several new tacrine-incorporated hybrids and derivates. There were two specific aims for this study: firstly, to explain the mechanisms of the adverse action of tacrine, as a distinctive example of a highly effective acetylcholinesterase inhibitor; and secondly to check whether luminal impedance planimetry is feasible for preclinical testing of possible side effects of compounds potentially toxic to the gastrointestinal tract. Methods: Six experimental pigs were used as the animal model in this study. Five major parameters were evaluated: luminal pressure (mmHg), estimated diameter (mm), cross-sectional area (mm2), distensibility (mm2/mmHg), and zone compliance (mm3/mmHg). All measurements were performed before and 360 min after intragastric administration of 200 mg tacrine (at the porcine tacrine Tmax). Results: This study consistently demonstrated an increase in luminal pressure (a directly measured indicator) for the particular balloon filling volumes used, and inversely a reciprocal decrease in the other parameters after tacrine administration. Conclusions: Endoscopic luminal impedance planimetry is a feasible method to evaluate functional response of the lower oesophageal sphincter to tacrine in experimental pigs. Tacrine did not compromise the function of the lower oesophageal sphincter either toward oesophageal spasms or, in contrast, decreased competence of the lower oesophageal sphincter.
- Publikační typ
- časopisecké články MeSH
Obezita se stala celosvětovým problémem s rostoucí incidencí představující riziko pro zdraví, zejména pro kardiovaskulární onemocnění, diabetes, některé typy nádorových onemocnění, depresivní syndrom a další. Metody léčby obezity se stále rozšiřují, kromě dietních a pohybových opatření je možná farmakologická, endoskopická a chirurgická léčba. Jednou z často prováděných bariatrických chirurgických operací je Roux-en-Y gastric bypass, který kombinuje restriktivní a malabsorpční účinky. V rámci rozvoje nových metod se začal provádět banded gastric bypass s využitím Fobi ringu. Jeho výhodou je vyšší účinnost při snižování a udržování hmotnosti. Jednou z popsaných komplikací je migrace Fobi ringu, kterou lze dnes řešit endoskopicky.
Obesity has become a worldwide problem with a growing incidence, posing a risk to health, especially for cardiovascular disease, diabetes, certain types of cancer, depressive syndrome, and others. The methods of obesity treatment are still expanding, in addition to diet and exercise measures, pharmacological, endoscopic and surgical treatment is possible. One of the commonly performed bariatric surgical procedures is the Roux-en-Y gastric bypass, which combines restrictive and malabsorptive effects. As part of the development of new methods, the banded gastric bypass using the Fobi ring has been introduced. Its advantage is greater efficiency in reducing and maintaining weight. One of the described complications is the migration of the Fobi ring, which can be addressed endoscopically today.
- Klíčová slova
- Fobi ring,
- MeSH
- gastrointestinální endoskopie MeSH
- lidé středního věku MeSH
- lidé MeSH
- migrace cizích těles * diagnostické zobrazování terapie MeSH
- morbidní obezita chirurgie komplikace MeSH
- Rouxova Y-anastomóza MeSH
- žaludeční bypass * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- gastroenterologie * dějiny MeSH
- lidé MeSH
- významné osobnosti * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- biografie MeSH
- O autorovi
- Kment, Milan, 1940-2024 Autorita
- MeSH
- gastrointestinální endoskopie * MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- úvodní články MeSH
- úvodníky MeSH
INTRODUCTION: Long-term outcome data are limited for non-achalasia esophageal motility disorders treated by peroral endoscopy myotomy (POEM) as a separate group. We investigated a subset of symptomatic patients with hypercontractile esophagus (Jackhammer esophagus). METHODS: Forty two patients (mean age 60.9 years; 57% female, mean Eckardt score 6.2 ± 2.1) treated by primary peroral myotomy for symptomatic Jackhammer esophagus 2012-2018 in seven European centers were retrospectively analyzed; myotomy included the lower esophageal sphincter but did not extend more than 1 cm into the cardia in contrast to POEM for achalasia. Manometry data were re-reviewed by an independent expert. The main outcome was the failure rate defined by retreatment or an Eckardt score >3 after at least two years following POEM. RESULTS: Despite 100% technical success (mean intervention time 107 ± 48.9 min, mean myotomy length 16.2 ± 3.7 cm), the 2-year success rate was 64.3% in the entire group. In a subgroup analysis, POEM failure rates were significantly different between Jackhammer-patients without (n = 22), and with esophagogastric junction outflow obstruction (EGJOO, n = 20) (13.6% % vs. 60%, p = 0.003) at a follow-up of 46.5 ± 19.0 months. Adverse events occurred in nine cases (21.4%). 14 (33.3%) patients were retreated, two with surgical fundoplication due to reflux. Including retreatments, an improvement in symptom severity was found in 33 (78.6%) at the end of follow-up (Eckardt score ≤3, mean Eckardt change 4.34, p < 0.001). EGJOO (p = 0.01) and frequency of hypercontractile swallows (p = 0.02) were predictors of POEM failure. The development of a pseudodiverticulum was observed in four cases within the subgroup of EGJOO. CONCLUSIONS: Patients with symptomatic Jackhammer without EGJOO benefit from POEM in long-term follow-up. Treatment of Jackhammer with EGJOO, however, remains challenging and probably requires full sphincter myotomy and future studies which should address the pathogenesis of this variant and alternative strategies.
- MeSH
- achalázie jícnu chirurgie diagnóza patofyziologie MeSH
- dolní jícnový svěrač chirurgie patofyziologie MeSH
- dospělí MeSH
- endoskopické operace přirozenými otvory metody škodlivé účinky MeSH
- ezofágoskopie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- manometrie * metody MeSH
- myotomie * metody MeSH
- následné studie MeSH
- poruchy motility jícnu * chirurgie diagnóza etiologie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
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.
- MeSH
- gastroparéza * chirurgie patofyziologie terapie etiologie MeSH
- lidé MeSH
- pyloromyotomie * metody škodlivé účinky MeSH
- pylorus * chirurgie patofyziologie MeSH
- recidiva MeSH
- výběr pacientů MeSH
- vyprazdňování žaludku MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Souhrn: Perorální endoskopická myotomie (POEM) je legitimní metodou léčby achalázie jícnu. V České republice se používá od roku 2012. V populaci dospělých pacientů je použití této metody již poměrně rozšířené. V pediatrii jsou však naše zkušenosti s tímto postupem zatím omezené. V této kazuistice prezentujeme, dle našich nejlepších znalostí, případ nejmladšího českého dítěte s achalázií jícnu, které ve věku necelých 4 let úspěšně podstoupilo POEM. Před léčbou bylo dítě často nemocné a neprospívalo, trpělo chronickým kašlem a opakovaným zvracením. Vzhledem k věku pacientky nebylo možné provést standardní high-resolution jícnovou manometrii. Diagnózu nakonec potvrdila inovativní endoluminální impedanční planimetrie, označovaná také jako FLIP (functional luminal imaging probe) topografie, kterou jsme provedli perioperačně. Případ našeho pacienta potvrzuje, že POEM lze v pediatrii považovat za rovnocennou alternativu laparoskopické nebo klasické myotomii. V rukou zkušeného endoskopisty se jedná o bezpečný a účinný postup. Díky této minimálně invazivní metodě může naše pacientka nyní plně rozvíjet svůj růstový potenciál bez omezujících příznaků achalázie jícnu.
Summary: Peroral endoscopic myotomy (POEM) is a legitimate method for treating esophageal achalasia. It has been used in the Czech Republic since 2012. In the adult patient population, use of this method is already quite widespread. In pediatrics, however, our experience with the procedure is still limited. In this case report, we present on the case of what is, according to our best knowledge, the youngest Czech child with esophageal achalasia who, at just under 4 years of age, successfully underwent POEM. Prior to treatment, the child was often sick and failing to thrive, suffering from chronic cough and recurrent vomiting. Thanks to this minimally invasive method, the child can now fully develop her growth potential without the limiting symptoms of esophageal achalasia. Due to the patient’s age, it was not possible to perform standard high-resolution esophageal manometry. The diagnosis was finally confirmed by innovative endoluminal impedance planimetry, called functional luminal imaging probe (FLIP) topography, which we performed perioperatively. Our patient’s case confirms that POEM can be considered an alternative equivalent to laparoscopic or classical myotomy in pediatrics. In the hands of an experienced endoscopist, it is a safe and effective procedure.
- MeSH
- achalázie jícnu * diagnostické zobrazování terapie MeSH
- elektrická impedance MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony MeSH
- předškolní dítě MeSH
- pyloromyotomie metody MeSH
- Check Tag
- lidé MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
