CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(08): E1031-E1036
DOI: 10.1055/a-0625-6288
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Peroral endoscopic myotomy is effective and safe in non-achalasia esophageal motility disorders: an international multicenter study

Mouen A. Khashab
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Pietro Familiari
 2  Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
,
Peter V. Draganov
 3  Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States
,
Hanaa Dakour Aridi
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Joo Young Cho
 4  Digestive Disease Center, CHA Budang Medical Center, CHA University, Seongnam, Korea
,
Michael Ujiki
 5  Department of Surgery, Section of Minimally Invasive Surgery, NorthShore University Health System, Evanston, Illinois, United States
,
Ricardo Rio Tinto
 6  Division of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles
,
Hubert Louis
 6  Division of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles
,
Pankaj N. Desai
 7  Surat Institute of Digestive Sciences, Surat, India
,
Vic Velanovich
 8  Division of General Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
,
Eduardo Albéniz
 9  Division of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
,
Amyn Haji
10  Department of Gastroenterology, Kings College Hospital NHS Foundation Trust, London, UK
,
Jeffrey Marks
11  Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
,
Guido Costamagna
 2  Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
,
Jacques Devière
 6  Division of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles
,
Yaseen Perbtani
 3  Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States
,
Mason Hedberg
 5  Department of Surgery, Section of Minimally Invasive Surgery, NorthShore University Health System, Evanston, Illinois, United States
,
Fermin Estremera
 9  Division of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
,
Luis A. Martin Del Campo
11  Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
,
Dennis Yang
 3  Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States
,
Majidah Bukhari
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Olaya Brewer
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Omid Sanaei
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Lea Fayad
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Amol Agarwal
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Vivek Kumbhari
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Yen-I Chen
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
12  Division of Gastroenterology and Hepatology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
› Author Affiliations
Further Information

Publication History

submitted 13 September 2017

accepted after revision 02 May 2018

Publication Date:
10 August 2018 (online)

Abstract

Background and study aims The efficacy of per oral endoscopic myotomy (POEM) in non-achalasia esophageal motility disorders such as esophagogastric junction outflow obstruction (EGJOO), diffuse esophageal spasm (DES), and jackhammer esophagus (JE) has not been well demonstrated. The aim of this international multicenter study was to assess clinical outcomes of POEM in patients with non-achalasia disorders, namely DES, JE, and EGJOO, in a large cohort of patients.

Patients and methods This was a retrospective study at 11 centers. Consecutive patients who underwent POEM for EGJOO, DES, or JE between 1/2014 and 9/2016 were included. Rates of technical success (completion of myotomy), clinical response (symptom improvement/Eckardt score ≤ 3), and adverse events (AEs, severity per ASGE lexicon) were ascertained.

Results Fifty patients (56 % female; mean age 61.7 years) underwent POEM for EGJOO (n = 15), DES (n = 17), and JE (n = 18). The majority of patients (68 %) were treatment-naïve. Technical success was achieved in all patients with a mean procedural time of 88.4 ± 44.7 min. Mean total myotomy length was 15.1 ± 4.7 cm. Chest pain improved in 88.9 % of EGJOO and 87.0 % of DES/JE (P = 0.88). Clinical success was achieved in 93.3 % of EGJOO and in 84.9 % of DES/JE (P = 0.41) with a median follow-up of 195 and 272 days, respectively. Mean Eckardt score decreased from 6.2 to 1.0 in EGJOO (P < 0.001) and from 6.9 to 1.9 in DES/JE (P < 0.001). A total of 9 (18 %) AEs occurred and were rated as mild in 55.6 % and moderate in 44.4 %.

Conclusion POEM is effective and safe in management of non-achalasia esophageal motility disorders, which include DES, JE, and EGJOO.