Endoscopy 2017; 49(07): 634-642
DOI: 10.1055/s-0043-105485
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Gastroesophageal reflux after peroral endoscopic myotomy: a multicenter case–control study

Vivek Kumbhari*
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Pietro Familiari*
2  Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
,
Niels Christian Bjerregaard
3  Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
,
Mathieu Pioche
4  Gastroenterologie, Pavillon H Hôpital Edouard Herriot, Lyon, France
,
Edward Jones
5  Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
,
Weon Jin Ko
6  Department of Gastroenterology, CHA Bundang Medical Center, Seongnam, Korea
,
Bu Hayee
7  Gastroenterology, King’s College Hospital, London, United Kingdom
,
Anna Cali
2  Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
,
Saowanee Ngamruengphong
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Francois Mion
8  Gastroenterologie, University of Lyon, Lyon, France
,
Ruben Hernaez
9  Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, United States
10  Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States
,
Sabine Roman
4  Gastroenterologie, Pavillon H Hôpital Edouard Herriot, Lyon, France
,
Alan H. Tieu
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Mohamad El Zein
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Tokunbo Ajayi
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Amyn Haji
7  Gastroenterology, King’s College Hospital, London, United Kingdom
,
Joo Young Cho
6  Department of Gastroenterology, CHA Bundang Medical Center, Seongnam, Korea
,
Jeffrey Hazey
5  Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
,
Kyle A. Perry
5  Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
,
Thierry Ponchon
4  Gastroenterologie, Pavillon H Hôpital Edouard Herriot, Lyon, France
,
Rastislav Kunda
3  Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
,
Guido Costamagna
2  Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
11  IHU-USIAS, University of Strasbourg, France
,
Mouen A. Khashab
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
› Author Affiliations
Further Information

Publication History

submitted 08 May 2016

accepted after revision 09 February 2017

Publication Date:
04 May 2017 (online)

Abstract

Background and study aims The variables associated with gastroesophageal reflux (GER) after peroral endoscopic myotomy (POEM) are largely unknown. This study aimed to: 1) identify the prevalence of reflux esophagitis and asymptomatic GER in patients who underwent POEM, and 2) evaluate patient and intraprocedural variables associated with post-POEM GER.

Patients and methods All patients who underwent POEM and subsequent objective testing for GER (pH study with or without upper gastrointestinal [GI] endoscopy) at seven tertiary academic centers (one Asian, two US, four European) were included. Patients were divided into two groups: 1) DeMeester score ≥ 14.72 (cases) and 2) DeMeester score of < 14.72 (controls). Asymptomatic GER was defined as a patient with a DeMeester score ≥ 14.72 who was not consuming proton pump inhibitor (PPI).

Results A total of 282 patients (female 48.2 %, Caucasian 84.8 %; mean body mass index 24.1 kg/m2) were included. Clinical success was achieved in 94.3 % of patients. GER evaluation was completed after a median follow-up of 12 months (interquartile range 10 – 24 months). A DeMeester score of ≥ 14.72 was seen in 57.8 % of patients. Multivariable analysis revealed female sex to be the only independent association (odds ratio 1.69, 95 % confidence interval 1.04 – 2.74) with post-POEM GER. No intraprocedural variables were associated with GER. Upper GI endoscopy was available in 233 patients, 54 (23.2 %) of whom were noted to have reflux esophagitis (majority Los Angeles Grade A or B). GER was asymptomatic in 60.1 %.

Conclusion Post-POEM GER was seen in the majority of patients. No intraprocedural variables were identified to allow for potential alteration in procedural technique.

* Co-first authors


Table e4 – e5