Outcomes of anterior versus posterior peroral endoscopic myotomy 2 years post-procedure: prospective follow-up results from a randomized clinical trial.
Endoscopy
; 53(5): 462-468, 2021 05.
Article
em En
| MEDLINE
| ID: mdl-32572862
ABSTRACT
BACKGROUND:
Peroral endoscopic myotomy (POEM) is considered a primary treatment modality for achalasia. It can be performed using either the anterior or posterior approach. A previous randomized clinical trial (RCT) showed that the posterior approach was noninferior to the anterior approach at 1 year post-POEM in terms of clinical success, rate of adverse event, and risk of gastroesophageal reflux disease (GERD). The aim of this post-RCT study was to compare outcomes at ≥â2 years post-POEM.METHODS:
Patients who previously completed the 1-year follow-up were contacted and their Eckardt, dysphagia, and GERD questionnaire (GERDQ) scores and frequency of proton pump inhibitor use were recorded. Clinical success was defined as an Eckardt score <â3.RESULTS:
150 patients were initially randomized and 138 completed the 1-year follow-up.âOf the 138, 111 (anterior group 54, posterior group 57) also completed ≥â2 years of follow-up, with an overall clinical success decrease from 89â% to 82â%. At ≥â2 years post-POEM, clinical success was achieved in 46/54 (85â%) and 45/57 (79â%) in the anterior and posterior groups, respectively (Pâ=â0.43). A similar decrease in clinical success was noted in both groups at ≥â2 years (anterior 90â% to 85â%; posterior 89â% to 79â%; Pâ=â0.47). GERDQ score was 6 (interquartile range 6â-â8; Pâ=â0.08) in both treatment groups.CONCLUSIONS:
The anterior and posterior POEM techniques remained equally effective at 2 years and decreases in efficacy were similar between the two approaches over time. GERD outcomes were also similar in both groups during medium-term follow-up.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Acalasia Esofágica
/
Refluxo Gastroesofágico
/
Cirurgia Endoscópica por Orifício Natural
/
Miotomia
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
Endoscopy
Ano de publicação:
2021
Tipo de documento:
Article