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Research Article|Articles in Press

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

      Publication history

      Accepted: December 1, 2022
      Received in revised form: November 14, 2022
      Received: August 29, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Grant Support and Writing Assistance: None

      ClinicalTrials.gov number, NCT02770859

      Author involvement: Study concept and design (JD); Acquisition of data (JD, CJ);

      Analysis and interpretation of data (JD, CJ, AP); Drafting of the article (JD, CJ); Critical revision of the manuscript for important intellectual content (all authors); Statistical analysis (JD, AP); Final approval (all authors)

      All authors had access to the study data and reviewed and approved the final manuscript.

      Disclosures: John DeWitt (consultant: Boston Scientific, Inc., Ariel, Inc, Vyaire Medical, Inc.), Sarah Stainko (none), Anthony Perkins (none), Mohammad A. Al-Haddad (Consultant: Boston Scientific Inc, Research/Grant support: Creatics LLC, Cook Endoscopy, Amplified Sciences; Teaching remuneration and consulting: Interpace Diagnostics), Chelsea C Jacobs (none)

      Identification

      DOI: https://doi.org/10.1016/j.gie.2022.12.006

      Copyright

      © 2022 by the American Society for Gastrointestinal Endoscopy

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