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Surgical Endoscopy

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07-03-2024 | Achalasia

Long-term efficacy of peroral endoscopic myotomy for achalasia under different criteria

Authors: Zhouyao Qian, Haisheng Qian, Xin Gao, Zhen Yang, Yun Wang, Xueliang Li, Weifeng Zhang, Guoxin Zhang, Xuan Li

Published in: Surgical Endoscopy | Issue 5/2024

Abstract

Background

Peroral endoscopic myotomy (POEM) has emerged as a widely accepted treatment for achalasia, with limited studies for over 2 years. Additionally, traditional measurements of achalasia after POEM have deficiencies. The study aimed to analyze the long-term outcomes of POEM under different criteria.

Methods

Patients with achalasia who received POEM between November 2012 and March 2021 were recruited. Patients and characteristics were shown, and risk factors related to two novel definitions of recurrence, symptomatic reflux, and reflux esophagitis were analyzed.

Results

Three hundred and twenty-one patients were included. At a median follow-up of 52 months, twenty-three failures happened (7.17%) under the modified criterion, and forty-seven failures occurred (14.64%) under the normal standard. Hospitalization (P = 0.027) and esophageal myotomy length (P = 0.039) were significantly associated with long-term efficacy under the modified and normal criteria, respectively. Fifty-two patients (16.20%) reported reflux symptoms and endoscopy performed in 88 patients revealed reflux esophagitis in 22 cases (25.00%). There were no predictors in the analysis of symptomatic reflux and gender (P = 0.010), LESP (P = 0.013), IRP (P = 0.015), and the esophageal myotomy length (P = 0.032) were statistically related to reflux esophagitis.

Conclusion

POEM is an extremely safe and effective treatment for achalasia with long-term follow-up. Shorter hospitalization and shorter esophageal myotomy length may decrease the incidence of recurrence under the modified and normal criteria, respectively. Long-term outcomes of POEM are unpredictable. No risk factors were related to symptomatic reflux, and male patients with low preoperative LESP and IRP needed relatively shorter esophageal myotomy to prevent reflux esophagitis.

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Title: Long-term efficacy of peroral endoscopic myotomy for achalasia under different criteria
Authors: Zhouyao Qian
Haisheng Qian
Xin Gao
Zhen Yang
Yun Wang
Xueliang Li
Weifeng Zhang
Guoxin Zhang
Xuan Li
Publication date: 07-03-2024
Publisher: Springer US
Keywords: Achalasia
Esophagitis
Gastroesophageal Reflux Disease
Dysphagia
Dysphagia
Dysphagia
Published in: Surgical Endoscopy / Issue 5/2024
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-024-10742-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Long-term efficacy of peroral endoscopic myotomy for achalasia under different criteria

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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