ABSTRACT
BACKGROUND: The use of peroral endoscopic myotomy (POEM) for achalasia has a high incidence of post-procedural gastroesophageal reflux (GER). Transoral incisionless fundoplication (TIF) may be an ideal endoscopic treatment. We report our experience with the use of post-POEM TIF. METHODS: In this multicenter retrospective study, post-POEM patients with GER who underwent TIF were included. The study end points were: (i) technical success; (ii) safety; (iii) effectiveness (changes in symptoms, scores, proton pump inhibitor [PPI] use, pH studies). RESULTS: 12 patients underwent TIF after POEM, nine of whom had daily symptoms, with 91.7% requiring twice daily (BID) PPIs. Technical success was achieved in all patients. Two adverse events occurred. There were significant decreases in the percentage of patients on BID PPIs (P = 0.03), frequency of daily symptoms (P = 0.03), Reflux Severity Index questionnaire, and GERD Health-related Quality of Life scores (P = 0.03 and P = 0.003; n = 6). pH studies performed in seven of the patients showed a significant reduction in the mean DeMeester score (P = 0.05) and mean percentage acid exposure time (P = 0.04). CONCLUSION: Our experience suggests that TIF may be effective and safe in treating GER after POEM. Larger prospective trials are needed.
Subject(s)
Esophageal Achalasia , Gastroesophageal Reflux , Myotomy , Natural Orifice Endoscopic Surgery , Esophageal Achalasia/complications , Esophageal Achalasia/surgery , Fundoplication/adverse effects , Gastroesophageal Reflux/epidemiology , Gastroesophageal Reflux/etiology , Gastroesophageal Reflux/surgery , Humans , Myotomy/adverse effects , Natural Orifice Endoscopic Surgery/adverse effects , Prospective Studies , Quality of Life , Retrospective Studies , Treatment OutcomeABSTRACT
Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clinical response of 82â% to 100â% in treatment of patients with achalasia. Data are limited on the long-term durability of the clinical response in these patients. The aim of this study was to determine the long-term outcomes of patients undergoing POEM for management of achalasia. Methods This was a retrospective multicenter cohort study of consecutive patients who underwent POEM for management of achalasia. Patients had a minimum of 4â years follow-up.âClinical response was defined by an Eckardt score ≤â3. Results A total of 146 patients were included from 11 academic medical centers. Mean (±âSD) age was 49.8 (±â16) years and 79 (54â%) were female. The most common type of achalasia was type II, seen in 70 (47.9â%) patients, followed by type I seen in 41 (28.1â%) patients. Prior treatments included: pneumatic dilation in 29 (19.9â%), botulinum toxin injection in 13 (8.9â%) and Heller myotomy in seven patients (4.8â%). Eight adverse events occurred (6 mucosotomies, 2 pneumothorax) in eight patients (5.5â%). Median follow-up duration was 55 months (IQR 49.9-60.6). Clinical response was observed in 139 (95.2â%) patients at follow-up of ≥â48 months. Symptomatic reflux after POEM was seen in 45 (32.1â%) patients, while 35.3â% of patients were using daily PPI at 48 months post POEM. Reflux esophagitis was noted in 16.8â% of patients who underwent endoscopy. Conclusion POEM is a durable and safe procedure with an acceptably low adverse event rate and an excellent long-term clinical response.