Outcomes of 100 Patients More Than 4 Years After POEM for Achalasia.
Ann Surg
; 273(6): 1135-1140, 2021 06 01.
Article
in En
| MEDLINE
| ID: mdl-33914488
ABSTRACT
OBJECTIVE:
We aim to describe the long-term follow-up data from our institution's POEM experience. SUMMARY BACKGROUND DATA Per-oral endoscopic myotomy (POEM) is a well-established endoscopic therapy for achalasia with excellent short-term efficacy, but long-term outcomes data are limited.METHODS:
Patients older than 4âyears removed from POEM for treatment of achalasia were studied. Clinical success was defined as an Eckardt Symptom (ES) score ≤3 and freedom from reintervention for achalasia. Patients underwent esophagogastroduodenoscopy (EGD), high-resolution manometry, impedance planimetry, and timed barium esophagram (TBE) preoperatively and at least 4âyears postoperatively. Objective gastroesophageal reflux disease (GERD) was defined LA Grade B or worse esophagitis on EGD.RESULTS:
One hundred and nineteen consecutive patients were included. Five patients died or had catastrophic events unrelated to achalasia or POEM. One hundred of the remaining patients (88%, 100/114) had long-term data available. Clinical follow-up for all patients was greater than 4âyears postoperatively and the mean was 55âmonths. Mean current ES was significantly improved from preop (n = 100, 1â±â1 vs 7â±â2, P < 0.001). Overall clinical success was 88% and 92%. Five patients had a current ES >3 and 4 patients required procedural reintervention on the lower esophageal sphincter. Reinterventions were successful in 75% of patients (3/4), with current ES ≤3. The rate of objective GERD was 33% (15/45). Esophageal physiology was improved with a decrease in median integrated relaxation pressure (11â±â4 vs 33â±â15âmm Hg, P < 0.001), a decrease in median TBE column height (3â±â3 vs 13â±â8âcm, P < 0.001), and an increase in median distensibility index (5.1â±â2 vs 1.1â±â1âmm2/mm Hg, P < 0.001).CONCLUSIONS:
POEM provides durable symptom relief and improvement in physiologic esophagogastric junction relaxation parameters over 4.5âyears postoperatively. Reinterventions are rare and effective.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Esophageal Achalasia
/
Pyloromyotomy
Type of study:
Observational_studies
Limits:
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Ann Surg
Year:
2021
Document type:
Article
Affiliation country:
Israel