Skip to main content
Erschienen in: Surgical Endoscopy 8/2017

18.11.2016

Pre-treatment Eckardt score is a simple factor for predicting one-year peroral endoscopic myotomy failure in patients with achalasia

verfasst von: Yutang Ren, Xiaowei Tang, Yanmin Chen, Fengping Chen, Yingying Zou, Zhiliang Deng, Jianuan Wu, Yan Li, Silin Huang, Bo Jiang, Wei Gong

Erschienen in: Surgical Endoscopy | Ausgabe 8/2017

Einloggen, um Zugang zu erhalten

Abstract

Background

Peroral endoscopic myotomy (POEM) is a novel treatment for achalasia with excellent outcomes. But the predictor for treatment failure is not well defined. This study was aimed to prospectively investigate the factors for predicting failed POEM.

Methods

From June 2011 to May 2015, a total of 115 achalasia patients treated by POEM were included for the retrospective cohort study from Nanfang Hospital and the First People’s Hospital of Yunnan Province. Patients were followed up with Eckardt score, high-resolution manometry and endoscope. POEM failure was defined as primary failure (Eckardt score failed to decrease to 3 or below) and recurrences (decrease of Eckardt score to 3 or below, then rise to more than 3) during one-year follow-up. Univariate and multivariate Cox regression analyses were performed to assess the predictive factor. For the associated factor, receiver operating characteristic curve (ROC) was utilized to determine the cutoff value of the predicting factor.

Results

The failure rate of POEM after 1 year was 7.0% (8/115), including 5 primary failure cases and 3 recurrences. Multivariate analysis showed higher pre-treatment Eckardt score was the single independent factor associated with POEM failure [9.5 (6–12) vs. 7 (2–12), odds ratio (OR) 2.24, 95 confidence interval (95% CI) 1.39–3.93, p = 0.001]. The cutoff value (Eckardt score ≥9) had 87.5 sensitivity (95% CI 47.3–99.7%) and 73.8% specificity (95% CI 64.4–81.9%) for predicting failed POEM.

Conclusions

Pre-treatment Eckardt score could be a predictive factor for failed POEM. Eckardt score ≥9 was associated with high sensitivity and specificity for predicting POEM failure.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Richter JE, Boeckxstaens GE (2011) Management of achalasia: surgery or pneumatic dilation. Gut 60:869–876CrossRefPubMed Richter JE, Boeckxstaens GE (2011) Management of achalasia: surgery or pneumatic dilation. Gut 60:869–876CrossRefPubMed
2.
Zurück zum Zitat Kashiwagi H, Omura N (2011) Surgical treatment for achalasia: when should it be performed, and for which patients? Gen Thorac Cardiovasc Surg 59:389–398CrossRefPubMed Kashiwagi H, Omura N (2011) Surgical treatment for achalasia: when should it be performed, and for which patients? Gen Thorac Cardiovasc Surg 59:389–398CrossRefPubMed
3.
Zurück zum Zitat Gockel HR, Schumacher J, Gockel I, Lang H, Haaf T, Nothen MM (2010) Achalasia: will genetic studies provide insights? Hum Genet 128:353–364CrossRefPubMed Gockel HR, Schumacher J, Gockel I, Lang H, Haaf T, Nothen MM (2010) Achalasia: will genetic studies provide insights? Hum Genet 128:353–364CrossRefPubMed
5.
Zurück zum Zitat Inoue H, Santi EG, Onimaru M, Kudo SE (2014) Submucosal endoscopy: from ESD to POEM and beyond. Gastrointest Endosc Clin N Am 24:257–264CrossRefPubMed Inoue H, Santi EG, Onimaru M, Kudo SE (2014) Submucosal endoscopy: from ESD to POEM and beyond. Gastrointest Endosc Clin N Am 24:257–264CrossRefPubMed
6.
Zurück zum Zitat Pasricha PJ, Hawari R, Ahmed I, Chen J, Cotton PB, Hawes RH, Kalloo AN, Kantsevoy SV, Gostout CJ (2007) Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia. Endoscopy 39:761–764CrossRefPubMed Pasricha PJ, Hawari R, Ahmed I, Chen J, Cotton PB, Hawes RH, Kalloo AN, Kantsevoy SV, Gostout CJ (2007) Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia. Endoscopy 39:761–764CrossRefPubMed
7.
Zurück zum Zitat Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271CrossRefPubMed Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271CrossRefPubMed
8.
Zurück zum Zitat Bechara R, Ikeda H, Inoue H (2015) Peroral endoscopic myotomy: an evolving treatment for achalasia. Nat Rev Gastroenterol Hepatol 12:410–426CrossRefPubMed Bechara R, Ikeda H, Inoue H (2015) Peroral endoscopic myotomy: an evolving treatment for achalasia. Nat Rev Gastroenterol Hepatol 12:410–426CrossRefPubMed
9.
Zurück zum Zitat Werner YB, Costamagna G, Swanström LL, von Renteln D, Familiari P, Sharata AM, Noder T, Schachschal G, Kersten JF, Rösch T (2016) Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut 65:899–906CrossRefPubMed Werner YB, Costamagna G, Swanström LL, von Renteln D, Familiari P, Sharata AM, Noder T, Schachschal G, Kersten JF, Rösch T (2016) Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut 65:899–906CrossRefPubMed
10.
Zurück zum Zitat Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE (2015) International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders v3.0. Neurogastroenterol Motil 27:160–174CrossRefPubMed Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE (2015) International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders v3.0. Neurogastroenterol Motil 27:160–174CrossRefPubMed
11.
Zurück zum Zitat Kurian AA, Dunst CM, Sharata A, Bhayani NH, Reavis KM, Swanström LL (2013) Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc 77:719–725CrossRefPubMed Kurian AA, Dunst CM, Sharata A, Bhayani NH, Reavis KM, Swanström LL (2013) Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc 77:719–725CrossRefPubMed
12.
Zurück zum Zitat Swanstrom LL, Kurian A, Dunst CM, Sharata A, Bhayani N, Rieder E (2012) Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg 256:659–667CrossRefPubMed Swanstrom LL, Kurian A, Dunst CM, Sharata A, Bhayani N, Rieder E (2012) Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg 256:659–667CrossRefPubMed
13.
Zurück zum Zitat Talukdar R, Inoue H, Nageshwar Reddy D (2015) Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis. Surg Endosc 29:3030–3046CrossRefPubMed Talukdar R, Inoue H, Nageshwar Reddy D (2015) Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis. Surg Endosc 29:3030–3046CrossRefPubMed
14.
Zurück zum Zitat Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstätter M, Lin F, Ciovica R (2009) Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 249:45–57CrossRefPubMed Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstätter M, Lin F, Ciovica R (2009) Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 249:45–57CrossRefPubMed
15.
Zurück zum Zitat Khajanchee YS, Kanneganti S, Leatherwood AE, Hansen PD, Swanström LL (2005) Laparoscopic Heller myotomy with Toupet fundoplication: outcomes predictors in 121 consecutive patients. Arch Surg 140:827–833CrossRefPubMed Khajanchee YS, Kanneganti S, Leatherwood AE, Hansen PD, Swanström LL (2005) Laparoscopic Heller myotomy with Toupet fundoplication: outcomes predictors in 121 consecutive patients. Arch Surg 140:827–833CrossRefPubMed
16.
Zurück zum Zitat Gaissert HA, Lin N, Wain JC, Fankhauser G, Wright CD, Mathisen DJ (2006) Transthoracic Heller myotomy for esophageal achalasia: analysis of long-term results. Ann Thorac Surg 81:2044–2049CrossRefPubMed Gaissert HA, Lin N, Wain JC, Fankhauser G, Wright CD, Mathisen DJ (2006) Transthoracic Heller myotomy for esophageal achalasia: analysis of long-term results. Ann Thorac Surg 81:2044–2049CrossRefPubMed
17.
Zurück zum Zitat Kilic A, Schuchert MJ, Pennathur A, Gilbert S, Landreneau RJ, Luketich JD (2009) Long-term outcomes of laparoscopic Heller myotomy for achalasia. Surgery 146:826–831CrossRefPubMed Kilic A, Schuchert MJ, Pennathur A, Gilbert S, Landreneau RJ, Luketich JD (2009) Long-term outcomes of laparoscopic Heller myotomy for achalasia. Surgery 146:826–831CrossRefPubMed
18.
Zurück zum Zitat Eckardt VF, Aignherr C, Bernhard G (1992) Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 103:1732–1738CrossRefPubMed Eckardt VF, Aignherr C, Bernhard G (1992) Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 103:1732–1738CrossRefPubMed
19.
Zurück zum Zitat Gockel I, Junginger T (2007) The value of scoring achalasia: a comparison of current systems and the impact on treatment–the surgeon’s viewpoint. Am Surg 73:327–331PubMed Gockel I, Junginger T (2007) The value of scoring achalasia: a comparison of current systems and the impact on treatment–the surgeon’s viewpoint. Am Surg 73:327–331PubMed
20.
Zurück zum Zitat Chen WF, Li QL, Zhou PH, Yao LQ, Xu MD, Zhang YQ, Zhong YS, Ma LL, Qin WZ, Hu JW, Cai MY, He MJ, Cui Z (2015) Long-term outcomes of peroral endoscopic myotomy for achalasia in pediatric patients: a prospective, single-center study. Gastrointest Endosc 81:91–100CrossRefPubMed Chen WF, Li QL, Zhou PH, Yao LQ, Xu MD, Zhang YQ, Zhong YS, Ma LL, Qin WZ, Hu JW, Cai MY, He MJ, Cui Z (2015) Long-term outcomes of peroral endoscopic myotomy for achalasia in pediatric patients: a prospective, single-center study. Gastrointest Endosc 81:91–100CrossRefPubMed
21.
Zurück zum Zitat Youssef Y, Richards WO, Sharp K, Holzman M, Sekhar N, Kaiser J, Torquati A (2007) Relief of dysphagia after laparoscopic Heller myotomy improves long-term quality of life. J Gastrointest Surg 11:309–313CrossRefPubMed Youssef Y, Richards WO, Sharp K, Holzman M, Sekhar N, Kaiser J, Torquati A (2007) Relief of dysphagia after laparoscopic Heller myotomy improves long-term quality of life. J Gastrointest Surg 11:309–313CrossRefPubMed
22.
Zurück zum Zitat Kurian AA, Dunst CM, Sharata A, Bhayani NH, Reavis KM, Swanström LL (2013) Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc 77:719–725CrossRefPubMed Kurian AA, Dunst CM, Sharata A, Bhayani NH, Reavis KM, Swanström LL (2013) Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc 77:719–725CrossRefPubMed
23.
Zurück zum Zitat Teitelbaum EN, Soper NJ, Pandolfino JE, Kahrilas PJ, Boris L, Nicodème F, Lin Z, Hungness ES (2014) An extended proximal esophageal myotomy is necessary to normalize EGJ distensibility during Heller myotomy for achalasia, but not POEM. Surg Endosc 28:2840–2847CrossRefPubMedPubMedCentral Teitelbaum EN, Soper NJ, Pandolfino JE, Kahrilas PJ, Boris L, Nicodème F, Lin Z, Hungness ES (2014) An extended proximal esophageal myotomy is necessary to normalize EGJ distensibility during Heller myotomy for achalasia, but not POEM. Surg Endosc 28:2840–2847CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Kadakia SC, Wong RK (1993) Graded pneumatic dilation using Rigiflex achalasia dilators in patients with primary esophageal achalasia. Am J Gastroenteol 88:34–38 Kadakia SC, Wong RK (1993) Graded pneumatic dilation using Rigiflex achalasia dilators in patients with primary esophageal achalasia. Am J Gastroenteol 88:34–38
25.
Zurück zum Zitat Kim CH, Cameron AJ, Hsu JJ, Talley NJ, Trastek VF, Pairolero PC, O’Connor MK, Colwell LJ, Zinsmeister AR (1993) Achalasia: prospective evaluation of relationship between lower esophageal sphincter pressure, esophageal transit, and esophageal diameter and symptoms in response to pneumatic dilation. Mayo Clin Proc 68:1067–1073CrossRefPubMed Kim CH, Cameron AJ, Hsu JJ, Talley NJ, Trastek VF, Pairolero PC, O’Connor MK, Colwell LJ, Zinsmeister AR (1993) Achalasia: prospective evaluation of relationship between lower esophageal sphincter pressure, esophageal transit, and esophageal diameter and symptoms in response to pneumatic dilation. Mayo Clin Proc 68:1067–1073CrossRefPubMed
26.
Zurück zum Zitat Moon JT, Jung IS, Kim YS, Cho SH, Park H, Lee SI (2008) Correlation between clinical symptoms and radiologic findings before and after pneumatic balloon dilatation for achalasia. Korean J Gastroenterol 52:16–20PubMed Moon JT, Jung IS, Kim YS, Cho SH, Park H, Lee SI (2008) Correlation between clinical symptoms and radiologic findings before and after pneumatic balloon dilatation for achalasia. Korean J Gastroenterol 52:16–20PubMed
27.
Zurück zum Zitat Vaezi MF, Baker ME, Achkar E, Richter JE (2002) Timed barium oesophagogram: better predict of long term success after pneumatic dilation in achalasia than symptom assessment. Gut 50:765–770CrossRefPubMedPubMedCentral Vaezi MF, Baker ME, Achkar E, Richter JE (2002) Timed barium oesophagogram: better predict of long term success after pneumatic dilation in achalasia than symptom assessment. Gut 50:765–770CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Sternbach JM, El Khoury R, Teitelbaum EN, Soper NJ, Pandolfino JE, Hungness ES (2015) Early esophagram in per-oral endoscopic myotomy (POEM) for achalasia does not predict long-term outcomes. Surgery 158:1128–1135CrossRefPubMed Sternbach JM, El Khoury R, Teitelbaum EN, Soper NJ, Pandolfino JE, Hungness ES (2015) Early esophagram in per-oral endoscopic myotomy (POEM) for achalasia does not predict long-term outcomes. Surgery 158:1128–1135CrossRefPubMed
29.
Zurück zum Zitat Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ (2008) Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 135:1526–1533CrossRefPubMedPubMedCentral Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ (2008) Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 135:1526–1533CrossRefPubMedPubMedCentral
30.
Zurück zum Zitat Kumbhari V, Tieu AH, Onimaru M, El Zein MH, Teitelbaum EN, Ujiki MB, Gitelis ME, Modayil RJ, Hungness ES, Stavropoulos SN, Shiwaku H, Kunda R, Chiu P, Saxena P, Messallam AA, Inoue H, Khashab MA (2015) Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open 3:E195–E201CrossRefPubMedPubMedCentral Kumbhari V, Tieu AH, Onimaru M, El Zein MH, Teitelbaum EN, Ujiki MB, Gitelis ME, Modayil RJ, Hungness ES, Stavropoulos SN, Shiwaku H, Kunda R, Chiu P, Saxena P, Messallam AA, Inoue H, Khashab MA (2015) Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open 3:E195–E201CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Khashab MA, Messallam AA, Onimaru M, Teitelbaum EN, Ujiki MB, Gitelis ME, Modayil RJ, Hungness ES, Stavropoulos SN, El Zein MH, Shiwaku H, Kunda R, Repici A, Minami H, Chiu PW, Ponsky J, Kumbhari V, Saxena P, Maydeo AP, Inoue H (2015) International multi-center experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video). Gastrointest Endosc 81:1170–1177CrossRefPubMed Khashab MA, Messallam AA, Onimaru M, Teitelbaum EN, Ujiki MB, Gitelis ME, Modayil RJ, Hungness ES, Stavropoulos SN, El Zein MH, Shiwaku H, Kunda R, Repici A, Minami H, Chiu PW, Ponsky J, Kumbhari V, Saxena P, Maydeo AP, Inoue H (2015) International multi-center experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video). Gastrointest Endosc 81:1170–1177CrossRefPubMed
32.
Zurück zum Zitat Rhee K, Jeon H, Kim JH, Yoon YH, Park H, Lee SI (2013) An evidence of esophageal decompensation in patients with achalasia in the view of its subtype: a retrospective study. J Neurogastroenterol Motil 19:319–323CrossRefPubMedPubMedCentral Rhee K, Jeon H, Kim JH, Yoon YH, Park H, Lee SI (2013) An evidence of esophageal decompensation in patients with achalasia in the view of its subtype: a retrospective study. J Neurogastroenterol Motil 19:319–323CrossRefPubMedPubMedCentral
33.
Zurück zum Zitat Shiino Y, Houghton SG, Filipi CJ, Awad ZT, Tomonaga T, Marsh RE (1999) Manometric and radiographic verification of esophageal body decompensation for patients with achalasia. J Am Coll Surg 189:158–163CrossRefPubMed Shiino Y, Houghton SG, Filipi CJ, Awad ZT, Tomonaga T, Marsh RE (1999) Manometric and radiographic verification of esophageal body decompensation for patients with achalasia. J Am Coll Surg 189:158–163CrossRefPubMed
34.
Zurück zum Zitat Vaezi MF, Pandolfino JE, Vela MF (2013) ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol 108:1238–1249CrossRefPubMed Vaezi MF, Pandolfino JE, Vela MF (2013) ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol 108:1238–1249CrossRefPubMed
35.
Zurück zum Zitat Hu JW, Li QL, Zhou PH, Yao LQ, Xu MD, Zhang YQ, Zhong YS, Chen WF, Ma LL, Qin WZ, Cai MY (2015) Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study. Surg Endosc 29:2841–2850CrossRefPubMed Hu JW, Li QL, Zhou PH, Yao LQ, Xu MD, Zhang YQ, Zhong YS, Chen WF, Ma LL, Qin WZ, Cai MY (2015) Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study. Surg Endosc 29:2841–2850CrossRefPubMed
36.
Zurück zum Zitat Inoue H, Sato H, Ikeda H, Onimaru M, Sato C, Minami H, Yokomichi H, Kobayashi Y, Grimes KL, Kudo SE (2015) J Am Coll Surg 221:256–264CrossRefPubMed Inoue H, Sato H, Ikeda H, Onimaru M, Sato C, Minami H, Yokomichi H, Kobayashi Y, Grimes KL, Kudo SE (2015) J Am Coll Surg 221:256–264CrossRefPubMed
Metadaten
Titel
Pre-treatment Eckardt score is a simple factor for predicting one-year peroral endoscopic myotomy failure in patients with achalasia
verfasst von
Yutang Ren
Xiaowei Tang
Yanmin Chen
Fengping Chen
Yingying Zou
Zhiliang Deng
Jianuan Wu
Yan Li
Silin Huang
Bo Jiang
Wei Gong
Publikationsdatum
18.11.2016
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 8/2017
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5352-5

Weitere Artikel der Ausgabe 8/2017

Surgical Endoscopy 8/2017 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.