CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(05): E650-E655
DOI: 10.1055/a-1120-8125
Original article

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
 1  Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
,
Robert A. Moran
 2  Department of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
,
Pietro Familiari
 3  Digestive Endoscopy Unit – Gemelli University Hospital,Rome, Italy
,
Mohamad H. Dbouk
 1  Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
,
Guido Costamagna
 3  Digestive Endoscopy Unit – Gemelli University Hospital,Rome, Italy
,
Yervant Ichkhanian
 1  Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
,
Stefan Seewald
 4  Center of Gastroenterolgy Hirslanden Private Clinic Group Witellikerstrasse 40, 8032 Zürich
,
Amol Bapaye
 5  Shivanand Desai Centre for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Centre, Pune, India
,
Joo Young Cho
 6  Digestive Endoscopy Center, CHA Bundang Hospital, South Korea
,
Maximilien Barret
 7  Department of gastroenterology, Cochin Hospital Paris, France
,
Nikolas Eleftheriadis
 8  Metropolitan Hospital, Athens, Greece
,
Mathieu Pioche
 9  Gastroenterology unit/unit of functional disease and digestive physiology, Edouard Herriot hospital, Lion, France
,
Bu' Hussain Hayee
10  Institute of Therapeutic Endoscopy, Kingʼs College Hospital NHS Foundation Trust, London, UK
,
Marcel Tantau
11  Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
Michael Ujiki
12  NorthShore University HealthSystem/University of Chicago Medical Center, Chicago, United States
,
Rosario Landi
 3  Digestive Endoscopy Unit – Gemelli University Hospital,Rome, Italy
,
Martina Invernizzi
 4  Center of Gastroenterolgy Hirslanden Private Clinic Group Witellikerstrasse 40, 8032 Zürich
,
In Kyung Yoo
 6  Digestive Endoscopy Center, CHA Bundang Hospital, South Korea
,
Sabine Roman
 9  Gastroenterology unit/unit of functional disease and digestive physiology, Edouard Herriot hospital, Lion, France
,
Amyn Haji
10  Institute of Therapeutic Endoscopy, Kingʼs College Hospital NHS Foundation Trust, London, UK
,
H. Mason Hedberg
12  NorthShore University HealthSystem/University of Chicago Medical Center, Chicago, United States
,
Nasim Parsa
 1  Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
,
Francois Mion
 9  Gastroenterology unit/unit of functional disease and digestive physiology, Edouard Herriot hospital, Lion, France
,
Lea Fayad
 1  Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
,
Vivek Kumbhari
 1  Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
,
Anant Agarwalla
 1  Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
,
Saowanee Ngamruengphong
 1  Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
,
Omid Sanaei
 1  Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
,
Thierry Ponchon
 9  Gastroenterology unit/unit of functional disease and digestive physiology, Edouard Herriot hospital, Lion, France
,
Mouen A. Khashab
 1  Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
› Author Affiliations
  

Abstract

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.



Publication History

Received: 25 April 2019

Accepted: 27 January 2020

Publication Date:
17 April 2020 (online)

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