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Prevalence and Impact of Opioid Use in Patients Undergoing Peroral Endoscopic Myotomy

Published:December 08, 2022DOI:https://doi.org/10.1016/j.gie.2022.12.006
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      ABSTRACT

      Background and Aims

      Chronic narcotic use may cause opioid-induced esophageal dysfunction (OIED) and associated type 3 achalasia, hypercontractile esophagus (HE), diffuse esophageal spasm (DES) and esophagogastric junction outflow obstruction (EGJOO). The frequency of opioid use and its impact on peroral endoscopic myotomy (POEM) in these patients is unknown.

      Methods

      Consecutive patients between 04/2017 and 09/2021 who underwent POEM for type III achalasia, EGJOO, DES, or HE with ≥6 months follow-up were identified. Baseline evaluation: EGD, high resolution esophageal manometry (HRM) and functional lumen impedance planimetry (FLIP) of the esophagogastric junction (EGJ). Eckardt scores (ES) were calculated at baseline and follow-up at 6-12 months post-POEM for opioid users and opioid non-users. Clinical response (CR) was defined as ES≤3, EGJ-distensibility index (DI)>2.8mm2/mmHg, maximum EGJ diameter (MxEGJD)>14mm and integrated relaxation pressure (IRP)<15mmHg. Opioid use prior to baseline HRM was assessed.

      Results

      126 patients underwent POEM and 89 had ≥6 months follow-up. Daily opioid use was present in 18/89 (20%). Baseline demographics, FLIP metrics, IRP, distribution of motility disorders and POEM characteristics were similar between both groups. At 6-12 months after POEM, clinical response as well as frequency of GERD, esophagitis, and PPI use were similar between opioid users and non-users. Heartburn was more frequent in the opioid group (82.4% vs 38.6%, p=0.002).

      Conclusion

      In this single center study of 89 patients with type III achalasia, EGJOO, DES, or HE treated with POEM, daily opioid use was present in 20%. Response to POEM and post-POEM GERD were similar between opioid and non-opioid users.

      Keywords

      Abbreviations:

      BMI (body mass index), DES (diffuse esophageal spasm), EGJ (esophagogastric junction), EGJOO (esophagogastric outlet obstruction), EGJ-DI (esophagogastric junction distensibility index), EGJOO (esophagogastric junction outflow obstruction), ES (Eckardt Score), FLIP (functional lumen imaging probe), HE (hypercontractile esophagus), HRM (high resolution esophageal manometry), IRP (integrated relaxation pressure), LES (lower esophageal sphincter), MxEGJD (maximum EGJ diameter), MME (morphine milligram equivalents), OIED (opioid-induced esophageal dysfunction), POEM (per-oral endoscopic myotomy)
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