Background and Aims
Chronic narcotic use may cause opioid-induced esophageal dysfunction and associated
type III 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 April 2017 and September 2021 who underwent POEM for
type III achalasia, EGJOO, DES, or HE with ≥6 months follow-up were identified. Baseline
evaluation was done with EGD, esophageal high-resolution manometry (HRM), and functional
lumen impedance planimetry (FLIP) of the esophagogastric junction (EGJ). Eckardt scores
(ESs) were calculated at baseline and follow-up at 6 to 12 months after POEM for opioid
users and nonusers. Clinical response was defined as ES ≤3, EGJ distensibility index
>2.8 mm2/mm Hg, maximum EGJ diameter >14 mm, and integrated relaxation pressure (IRP) <15 mm
Hg. Opioid use before baseline HRM was assessed.
Results
One hundred twenty-six patients underwent POEM, and 89 had ≥6 months of follow-up.
Daily opioid use was present in 18 of 89 patients (20%). Baseline demographics, FLIP
metrics, IRP, distribution of motility disorders, and POEM characteristics were similar
between both groups. At 6 to 12 months after POEM, clinical response and frequency
of GERD, esophagitis, and proton pump inhibitor use were similar between opioid users
and nonusers. Heartburn was more frequent in the opioid group (82.4% vs 38.6%, P = .002).
Conclusions
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 users and nonusers. (Clinical trial registration
number: NCT02770859.)
Abbreviations:
DES (diffuse esophageal spasm), EGJ (esophagogastric junction), 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 manometry), IRP (integrated relaxation pressure), MME (morphine milligram equivalents), OIED (opioid-induced esophageal dysfunction), POEM (peroral endoscopic myotomy), PPI (proton pump inhibitor)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 08, 2022
Accepted:
December 1,
2022
Received:
August 29,
2022
Footnotes
DISCLOSURE: The following authors disclosed financial relationships: M. Al-Haddad: Consultant for Boston Scientific and Interpace Diagnostics; research support from Creatics LLC, Cook Endoscopy, and Amplified Sciences. J. M. DeWitt: Consultant for Boston Scientific, Ariel, and Vyaire Medical.
Identification
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© 2023 by the American Society for Gastrointestinal Endoscopy
