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Surgical Endoscopy

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01-12-2021 | Achalasia

Peroral endoscopic myotomy for the treatment of achalasia after failed pneumatic dilation

Authors: Hong Jin, Bin Wang, Zhong-qing Zheng, Li-li Zhang, Qiu-yu Chen, Chun Shan Zhao, Bang-mao Wang, Wei Zhao

Published in: Surgical Endoscopy | Issue 12/2021

Abstract

Background and aims

POEM is a rescue endoscopic therapy for patients who had previously failed surgical or endoscopic treatment. However, data regarding its effectiveness after failed pneumatic dilation (PD) and its long-term effects are limited. We aimed to retrospectively investigate the long-term outcomes in patients who had undergone POEM after failed PD.

Methods

Data from 66 achalasia patients with a 2-year follow-up period were analyzed. Intraprocedural events were compared between the first POEM group (patients without prior-endoscopic intervention) and prior PD group (patients who had pre-POEM PD). Symptom evaluation, HRM and 24 h-pH DeMeester scores between the two groups were performed at 2 years after the POEM procedure. Muscularis externa samples were obtained from the lower esophagus using POEM to assess the muscle fibrosis with Azan-Mallory staining.

Results

POEM was successfully performed for all achalasia patients. During the 2-year follow-up period, the success rate of POEM was 96.15% (25/26) for patients with prior PD and 95% (38/40) with primary POEM. For patients with type II achalasia and who underwent prior PD, the post-procedure DeMeester score was higher compared to patients who underwent POEM only (P < 0.05). A larger number of patients who underwent primary POEM (27.50%, 11/40) complained of mild heartburn compared to patients who underwent POEM after PD (7.69%, 2/26) (P < 0.05). With regards to fibrosis, the majority of patients who underwent POEM only were classified as F-1 (45.00%, 18/40), while the majority of patients who underwent prior PD were classified as F-2 (42.3%, 11/26). The degree of fibrosis was significantly different between the two groups (P < 0.05). Both surgical time and prior PD were correlated with the degree of fibrosis (P < 0.05).

Conclusions

Despite the technical challenges, pre-POEM endoscopic treatment does not impact the safety and efficacy of POEM in achalasia patients. Longer follow-up studies using larger cohorts are needed to determine long-term outcomes and complications of POEM.

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Title: Peroral endoscopic myotomy for the treatment of achalasia after failed pneumatic dilation
Authors: Hong Jin
Bin Wang
Zhong-qing Zheng
Li-li Zhang
Qiu-yu Chen
Chun Shan Zhao
Bang-mao Wang
Wei Zhao
Publication date: 01-12-2021
Publisher: Springer US
Keyword: Achalasia
Published in: Surgical Endoscopy / Issue 12/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-08207-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Peroral endoscopic myotomy for the treatment of achalasia after failed pneumatic dilation

Abstract

Background and aims

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and aims

Methods

Results

Conclusions

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