Journal
DIGESTIVE ENDOSCOPY
Volume 30, Issue 1, Pages 52-56Publisher
WILEY
DOI: 10.1111/den.12918
Keywords
achalasia; endoscopy; esophagus; Heller myotomy; peroral endoscopic myotomy (POEM)
Categories
Funding
- Boston Scientific
- Fujinon
- EMcison
- Xlumena Inc.
- W.L. Gore
- MaunaKea
- Apollo Endosurgery
- Cook Endoscopy
- ASPIRE Bariatrics
- GI Dynamics
- NinePoint Medical
- Merit Medical
- Olympus
- MI Tech
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Background: Treatment for achalasia has traditionally been Heller myotomy (HM). Despite its excellent efficacy rate, a number of patients remain symptomatic post-procedure. Limited data exist as to the best management for recurrence of symptoms post-HM. We present an international, multicenter experience evaluating the efficacy and safety of post-HM peroral endoscopic myotomy (POEM). Methods: Patients who underwent POEM post-HM from 13 centers from January 2012 to January 2017 were included as part of a prospective registry. Technical success was defined as successful completion of the myotomy. Clinical success was defined as an Eckardt score of <= 3 on 12-month follow up. Adverse events (AE) including anesthesia-related, operative, and postoperative complications were recorded. Results: Fifty-one patients were included in the study (mean age 54.2, 47% male). Technical success was achieved in 100% of patients. Clinical success on long-term follow up was achieved in 48 patients (94%), with a mean change in Eckardt score of 6.25. Seven patients (13%) had AE: six experienced periprocedural mucosal defect treated endoscopically and two patients developed mediastinitis treated conservatively. Conclusion: For patients with persistent symptoms after HM, POEM is a safe salvation technique with good short-term efficacy. As a result of the challenge associated with repeat HM, POEM might become the preferred technique in this patient population. Further studies with longer follow up are needed.
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