Gastroesophageal reflux disease after peroral endoscopic myotomy: Short-term, medium-term, and long-term resultsGastroesophageal reflux disease after peroral endoscopic myotomy (POEM)

Abstract

Introduction and aims: Achalasia is characterized by incomplete relaxation of the lower esophageal sphincter and esophageal aperistalsis. The efficacy of peroral endoscopic myotomy (POEM) is similar to that of the Heller myotomy, with an apparently greater prevalence of gastroesophageal reflux disease. Our aim was to determine the presence of GERD in a post-POEM cohort of Mexican patients with achalasia and follow-up of at least 12 months. Materials and methods: A retrospective cohort study was conducted on post-POEM patients with a minimum of 12 months of follow-up, within the time frame of 2012 to 2017. Pregnant patients were excluded. Serial endoscopy, pH study, and GERDQ application were performed. Univariate and bivariate data analyses were carried out and statistical significance was set at a P < 0.05. Results: Sixty-eight patients had post-POEM follow-up for 12 months. Of those patients, follow-up continued to 24 months for 58, 36 months for 47, 48 months for 39, and 60 months for 25. Mean patient age was 47.8 ± 14.3 years, 57.3% of the patients were women, 77.9% were treatment-naïve, and 54.4% had type II achalasia. The pH study, endoscopy, and questionnaire were positive in 73, 28, and 18% at 3 months; 48, 35, and 13% at 6 months, and 55, 30, and 15% at 12 months, respectively. Once the proton pump inhibitor was begun, the percentages decreased to 5, 2, and 6% at 24 months; 6, 2, and 8% at 36 months; 4,1, and 6% at 48 months; and 3, 1, and 4% at 60 months, respectively. There was no relation between the efficacy of POEM and the presence or intensity of GERD. There were no secondary complications due to gastroesophageal reflux. Conclusions: The post-POEM prevalence of GERD was 50% in the short term (12 months), with no evidence of complications at the medium term or long term (60 months). Gastroesophageal reflux was adequately controlled through proton pump inhibitors administration in over 95% of the cases. Resumen: Introducción y objetivos: La acalasia se caracteriza por una relajación incompleta del esfínter esofágico inferior y aperistalsis esofágica. La miotomía endoscópica por la boca (POEM) brinda una eficacia similar y aparentemente mayor prevalencia de la enfermedad de reflujo gastroesofágico (ERGE) que la miotomía de Heller. Nuestro objetivo fue determinar la presencia de la ERGE en una cohorte de pacientes mexicanos pos-POEM con acalasia y un seguimiento mínimo de 12 meses. Material y métodos: Se trata de un estudio de cohorte retrospectivo en el que se incluyó a pacientes pos-POEM con un mínimo de 12 meses de seguimiento entre 2012 y 2017; se excluyó a pacientes embarazadas. Se realizaron endoscopia, pHmetría y cuestionario GERDQ de forma seriada. Los datos se analizaron de forma univariada y bivariada considerando una p < 0.05 como estadísticamente significativa. Resultados: El seguimiento se completó en 68 pacientes (12 meses); 58 (24 meses); 47 (36 meses); 39 (48 meses) y 25 pacientes (60 meses) pos-POEM; con una edad de 47.8 ± 14.3 años; con un 57.3% de mujeres, 77.9% vírgenes para el método y un 54.4% con acalasia de tipo II. La phmetría, endoscopia y cuestionario fueron positivos en 73, 28% y 18% (3 meses); en 48, 35 y 13% (6 meses) y en 55, 30 y 15% (12 meses) y, una vez iniciado el inhibidor de bomba de protones, los valores disminuyeron a 5, 2 y 6% (24 meses); a 6, 2 y 8% (36 meses); a 4, 1 y 6% (48 meses) y a 3, 1 y 4% (60 meses), respectivamente. No hubo relación entre la eficacia de la POEM y la presencia o intensidad de la ERGE, ni complicaciones secundarias a su presencia. Conclusiones: La prevalencia de la ERGE pos-POEM es de hasta el 50% a corto plazo (12 meses), pero sin evidencia de complicaciones a mediano y largo plazo (60 meses) y puede ser controlada adecuadamente con inhibidores de la bomba de protones en más del 95% de los casos. Keywords: Achalasia, POEM, Gastroesophageal reflux, Mexican population, Palabras clave: Acalasia, Miotomía endoscópica, Reflujo gastroesofágico, Población mexicana