Subscribe to RSS
DOI: 10.1055/a-0658-5783
The effect of prior treatment on clinical outcomes in patients with achalasia undergoing peroral endoscopic myotomy
Publication History
submitted 24 January 2018
accepted after revision 11 June 2018
Publication Date:
27 September 2018 (online)
Abstract
Background Peroral endoscopic myotomy (POEM) is a treatment option for patients with previous surgical or endoscopic treatment. We aimed to evaluate the influence of prior treatment on perioperative and follow-up outcomes in patients undergoing POEM.
Methods From August 2010 to December 2014, a total of 1384 patients with achalasia underwent POEM at our center. We retrospectively reviewed 849 patients who completed follow-up. Patients with an Eckardt score ≥ 4 after POEM were considered to have a clinical failure. We compared variables between patients with and without prior treatment. We analyzed risk factors for perioperative major adverse events, and clinical reflux and failure during follow-up.
Results 245 patients (28.9 %) had undergone prior treatment, and 34 patients (4.0 %) experienced a major adverse event associated with the POEM procedure. During a median follow-up of 23 months (range 1 – 71), clinical reflux occurred in 203 patients (23.9 %) and clinical failure was recorded for 94 patients (11.1 %). Patients with prior treatment had a longer procedure duration (P = 0.001) and longer hospital stay after POEM (P = 0.001). Prior treatment was not an independent risk factor for major adverse events or clinical reflux (odds ratio [OR] 1.19, P = 0.65; OR 1.26, P = 0.19; logistic regression), but it did increase the rate of clinical failure during follow-up (hazard ratio 1.90, P = 0.002; Cox regression).
Conclusions POEM was performed safely with a low rate of major adverse events in patients with achalasia who had undergone prior surgical or endoscopic treatment. However, prior treatment increased the risk of clinical failure after POEM.
* These authors contributed equally to this work.
-
References
- 1 Bechara R, Ikeda H, Inoue H. Peroral endoscopic myotomy: an evolving treatment for achalasia. Nat Rev Gastroenterol Hepatol 2015; 12: 410-426
- 2 Bechara R, Onimaru M, Ikeda H. et al. Per-oral endoscopic myotomy, 1000 cases later: pearls, pitfalls, and practical considerations. Gastrointest Endosc 2016; 84: 330-338
- 3 Li QL, Zhou PH. Perspective on peroral endoscopic myotomy for achalasia: Zhongshan experience. Gut Liver 2015; 9: 152-158
- 4 Ngamruengphong S, Inoue H, Chiu PW. et al. Long-term outcomes of per-oral endoscopic myotomy in patients with achalasia with a minimum follow-up of 2 years: an international multicenter study. Gastrointest Endosc 2017; 85: 927-933
- 5 Familiari P, Gigante G, Marchese M. et al. Peroral endoscopic myotomy for esophageal achalasia: outcomes of the first 100 patients with short-term follow-up. Ann Surg 2016; 263: 82-87
- 6 Von Renteln D, Fuchs KH, Fockens P. et al. Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology 2013; 145: 309-311
- 7 Orenstein SB, Raigani S, Wu YV. et al. Peroral endoscopic myotomy (POEM) leads to similar results in patients with and without prior endoscopic or surgical therapy. Surg Endosc 2015; 29: 1064-1070
- 8 Zhou PH, Li QL, Yao LQ. et al. Peroral endoscopic remyotomy for failed Heller myotomy: a prospective single-center study. Endoscopy 2013; 45: 161-166
- 9 Jones EL, Meara MP, Pittman MR. et al. Prior treatment does not influence the performance or early outcome of per-oral endoscopic myotomy for achalasia. Surg Endosc 2016; 30: 1282-1286
- 10 Sharata A, Kurian AA, Dunst CM. et al. Peroral endoscopic myotomy (POEM) is safe and effective in the setting of prior endoscopic intervention. J Gastrointest Surg 2013; 17: 1188-1192
- 11 Kristensen HO, Kirkegard J, Kjaer DW. et al. Long-term outcome of peroral endoscopic myotomy for esophageal achalasia in patients with previous Heller myotomy. Surg Endosc 2017; 31: 2596-2601
- 12 Ngamruengphong S, Inoue H, Ujiki MB. et al. Efficacy and safety of peroral endoscopic myotomy for treatment of achalasia after failed Heller myotomy. Clin Gastroenterol Hepatol 2017; 15: 1531-1537
- 13 Nabi Z, Ramchandani M, Chavan R. et al. Peroral endoscopic myotomy in treatment-naive achalasia patients versus prior treatment failure cases. Endoscopy 2018; 50: 358-370
- 14 Zhang X, Modayil RJ, Friedel D. et al. Per-oral endoscopic myotomy in patients with or without prior Heller’s myotomy: comparing long-term outcomes in a large US. single-center cohort (with videos). Gastrointest Endosc 2018; 87: 972-985
- 15 Ren Y, Tang X, Chen Y. et al. Pre-treatment Eckardt score is a simple factor for predicting one-year peroral endoscopic myotomy failure in patients with achalasia. Surg Endosc 2017; 31: 3234-3241
- 16 Zhang XC, Li QL, Xu MD. et al. Major perioperative adverse events of peroral endoscopic myotomy: a systematic 5-year analysis. Endoscopy 2016; 48: 967-978
- 17 Li QL, Wu QN, Zhang XC. et al. Outcomes of per-oral endoscopic myotomy for treatment of esophageal achalasia with a median follow-up of 49 months. Gastrointest Endosc 2018; 87: 1405-1412
- 18 Jones R, Junghard O, Dent J. et al. Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther 2009; 30: 1030-1038
- 19 Emami MH, Raisi M, Amini J. et al. Pneumatic balloon dilation therapy is as effective as esophagomyotomy for achalasia. Dysphagia 2008; 23: 155-160
- 20 Boeckxstaens GE, Annese V, des VarannesSB. et al. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med 2011; 364: 1807-1816
- 21 Borges AA, Lemme EM, Abrahao LJ. et al. Pneumatic dilation versus laparoscopic Heller myotomy for the treatment of achalasia: variables related to a good response. Dis Esophagus 2014; 27: 18-23
- 22 Inoue H, Sato H, Ikeda H. et al. Per-oral endoscopic myotomy: a series of 500 patients. J Am Coll Surg 2015; 221: 256-264
- 23 Veenstra BR, Goldberg RF, Bowers SP. et al. Revisional surgery after failed esophagogastric myotomy for achalasia: successful esophageal preservation. Surg Endosc 2016; 30: 1754-1761
- 24 Kilic A, Schuchert MJ, Pennathur A. et al. Long-term outcomes of laparoscopic Heller myotomy for achalasia. Surgery 2009; 146: 826-833
- 25 Nau P, Rattner D. Laparoscopic Heller myotomy as the gold standard for treatment of achalasia. J Gastrointest Surg 2014; 18: 2201-2207