Navegando por Palavras-chave "Achalasia"

Agora exibindo 1 - 3 de 3
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Achalasia treatment in patients over 80 years of age. A multicenter survey.
    (Universidade Federal de São Paulo (UNIFESP), 2019-10-31) Zotti, Orlando Rondan [UNIFESP]; Fernandes, Fernando Augusto Mardiros Herbella [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Achalasia has a bimodal distribution of incidence according to age with peaks at around 30 and 60 years [1]. Laparoscopic Heller´s myotomy (LHM), per oral endoscopic myotomy (POEM) and pneumatic dilatation (PD) are well-established methods to treat achalasia [2]. It is known that PD has low success rates in young patients [3] but the ideal treatment algorithmin the older patients is, however, still elusive. Age and co-morbities may influence clinical decision towards less invasive procedures. This multicenter study aims to review outcomes and changes in routine clinical therapeutic options in achalasia patients over 80 years of age. Background and aims: laparoscopic heller's myotomy (lhm), per oral endoscopic myotomy (poem) and pneumatic dilatation (pd) are well-established methods to treat achalasia. The ideal treatment algorithm in elderly patients is, however, still elusive. This multicenter study aims to evaluate outcomes and changes in routine therapeutic options in patients over 80 years of age. Methods: worldwide high volume centers for the treatment of achalasia were surveyed. Therapeutic options and outcomes in patients over 80 years of age were reviewed. Results: 85 (54% males, mean age 84±4 years) patients were studied. Primary treatment was endoscopic in 43 (51%) patients; surgical in 39 (46%) patients (30 lhm, 9 cardioplasty + gastrectomy); and medical in 3 (4%) patients. Four centers tailored treatment based on age (14% of the patients). Secondary treatment was necessary in 34 (40%) patients; 30 of them with endoscopic treatment as primary treatment. Lhm performed in 20 patients and endoscopic treatment in 14. A total of 11 (13%) patients had complications after lhm. Seven had lhm or cardioplasty + gastrectomy as primary treatment. Four had lhm as secondary treatment. The mean time of hospitalization was 4±2 days for those who did not had complications, and 7±6 days for those who had complications. Conclusion: most specialized centers do not tailor treatment based on advanced age. Treatment of the oldest-old patients should be based solely on their physiologic and mental health not their age. Endoscopic treatment has a high rate of recurrence and gastrectomy a high rate of complications in his population. Lhm seems to be a safe option with good outcomes in this population.
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Benign Esophagopulmonary Fistula Through an Epiphrenic Diverticulum and Asymptomatic Achalasia
    (Springer, 2010-04-01) Herbella, Fernando A. M. [UNIFESP]; Del Grande, Jose C. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Novas técnicas ambulatoriais para avaliação da motilidade esofágica e sua aplicação no estudo do megaesôfago
    (Colégio Brasileiro de Cirurgiões, 2008-06-01) Herbella, Fernando A. M. [UNIFESP]; Del Grande, José Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Brazilian surgeons deal routinely with esophageal motility disorders, because achalasia is highly prevalent in Brazil due to Chagas' disease. In the last years new technologies for the evaluation of esophageal motility became available. High resolution manometry and the combination of barometric parameters and intraluminal impedance are the new frontiers on this topic. The authors reviewed current, national and international, literature about achalasia with multichannel intraluminal impedance and high resolution manometry studies. The new technologies described are promising, however few studies have been published and further studies are still expected for achalasia patients.