Endoscopy International Open (Apr 2020)

Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study

  • Olaya I. Brewer Gutierrez,
  • Robert A. Moran,
  • Pietro Familiari,
  • Mohamad H. Dbouk,
  • Guido Costamagna,
  • Yervant Ichkhanian,
  • Stefan Seewald,
  • Amol Bapaye,
  • Joo Young Cho,
  • Maximilien Barret,
  • Nikolas Eleftheriadis,
  • Mathieu Pioche,
  • Bu' Hussain Hayee,
  • Marcel Tantau,
  • Michael Ujiki,
  • Rosario Landi,
  • Martina Invernizzi,
  • In Kyung Yoo,
  • Sabine Roman,
  • Amyn Haji,
  • H. Mason Hedberg,
  • Nasim Parsa,
  • Francois Mion,
  • Lea Fayad,
  • Vivek Kumbhari,
  • Anant Agarwalla,
  • Saowanee Ngamruengphong,
  • Omid Sanaei,
  • Thierry Ponchon,
  • Mouen A. Khashab

DOI
https://doi.org/10.1055/a-1120-8125
Journal volume & issue
Vol. 08, no. 05
pp. E650 – E655

Abstract

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Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clinical response of 82 % to 100 % 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 4 years follow-up. Clinical response was defined by an Eckardt score ≤ 3. Results A total of 146 patients were included from 11 academic medical centers. Mean (± SD) age was 49.8 (± 16) years and 79 (54 %) were female. The most common type of achalasia was type II, seen in 70 (47.9 %) patients, followed by type I seen in 41 (28.1 %) patients. Prior treatments included: pneumatic dilation in 29 (19.9 %), botulinum toxin injection in 13 (8.9 %) and Heller myotomy in seven patients (4.8 %). Eight adverse events occurred (6 mucosotomies, 2 pneumothorax) in eight patients (5.5 %). Median follow-up duration was 55 months (IQR 49.9–60.6). Clinical response was observed in 139 (95.2 %) patients at follow-up of ≥ 48 months. Symptomatic reflux after POEM was seen in 45 (32.1 %) patients, while 35.3 % of patients were using daily PPI at 48 months post POEM. Reflux esophagitis was noted in 16.8 % 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.