John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Endoscopic treatment of functional digestive diseases: new perspectives Volume 23, issue 4, Avril 2016

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Authors
1 Hôpital Nord, service de gastroentérologie,
Chemin des Bourrely,
13915 Marseille cedex 20,
France
2 Aix-Marseille-Université,
plateforme d’interface clinique,
CRN2M, UMR 7286,
Marseille, France
* Tirés à part

Functional motility disorders in the upper and the lower GI tract deeply affect quality of life of the patients, and the medical treatment remains disappointing. Recently, endoscopy popped up in the management with promising preliminary outcomes, which have been confirmed in several further studies. Rising of these new endoscopic techniques allowed for a substantial clinical improvement in patients in situation of therapeutic failure. Concerned diseases are achalasia, gastroparesis, severe constipation and fecal incontinence. Regarding the upper GI disorders, the submucosal endoscopy with myotomies after tunnel supplanted conventional endoscopic methods. The most accomplished and validated technique is the esophageal POEM, which is becoming a standard in terms of efficacy as well as morbidity. It achieves a better efficacy than pneumatic dilation, and is equivalent to Heller myotomy. Likewise, first cases of pylorotomies by gastric POEM have been described in the treatment of refractory gastroparesis. Outcomes are really promising and need to be confirmed in further prospective studies. Regarding lower GI disorders, especially refractory and severe constipation, a new approach consisting in endoscopic caecostomy, close to Malone intervention, lead to a significant improvement of patients’ symptoms and quality of life. Finally, intra-rectal endoscopic injection of Botulinum toxin for treating fecal incontinence showed very hopeful results, and extend the therapeutic armamentarium is such disabling disease. In conclusion, these last past years we have seen a convergence between the digestive functional diseases and the therapeutic endoscopy, offering new hope to patients refractory to conventional treatment.