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

Kniha představuje nejlepší současný návod nejen pro vlastní léčbu, ale i pro celkovou péči o nemocné s touto velmi rozšířenou diagnózou.

• Klíčová slova
• Gastroenterologie, hepatologie,
• MeSH
• Barrettův syndrom diagnóza   terapie   MeSH
• eozinofilní ezofagitida MeSH
• gastroezofageální reflux diagnóza   epidemiologie   komplikace   patofyziologie   terapie   MeSH
• infekce vyvolané Helicobacter pylori MeSH
• komorbidita MeSH

• NLK Obory
• gastroenterologie

• NLK Publikační typ
• kolektivní monografie

• MeSH
• Barrettův syndrom diagnóza   terapie   MeSH
• eozinofilní ezofagitida MeSH
• gastroezofageální reflux diagnóza   epidemiologie   komplikace   patofyziologie   terapie   MeSH
• infekce vyvolané Helicobacter pylori MeSH
• komorbidita MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• gastroenterologie
• NLK Publikační typ
• kolektivní monografie