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Surgical Endoscopy

Published in:

01-04-2016

Prior treatment does not influence the performance or early outcome of per-oral endoscopic myotomy for achalasia

Authors: Edward L. Jones, Michael P. Meara, Matthew R. Pittman, Jeffrey W. Hazey, Kyle A. Perry

Published in: Surgical Endoscopy | Issue 4/2016

Abstract

Introduction

Per-oral endoscopic myotomy (POEM) is an emerging treatment for achalasia. Pneumatic dilation, botulinum toxin injection, and previous myotomy increase the difficulty of subsequent Heller myotomy, but their impact on POEM remains unknown. The purpose of this study was to compare patients who had undergone prior treatment for their achalasia to those undergoing POEM as an initial therapy.

Methods and Procedures

All patients undergoing POEM were entered into a prospective database from August 2012 to October 2014. Data collected included demographics, dysphagia and symptom survey scores, operative time, clips required for mucosotomy closure, perioperative complications and length of hospital stay.

Results

Forty-five patients underwent POEM during the study period. Fifteen (30 %) had undergone previous treatment (seven Botox injection, five pneumatic dilation and three Heller myotomy). Primary POEM patients were younger than those who had had prior treatment (mean age 46 ± 17 vs. 64 ± 12 years, p < 0.001), but gender, body mass index and ASA class were not significantly different. There were no conversions to Heller myotomy or perioperative complications in either group. Operative time for primary POEM was 103 ± 27 versus 102 ± 29 min following prior treatment (p = 0.84). Mucosotomy closure required a median 7 (4–16) and 8 (5–16) clips, respectively (p = 0.08). Length of stay was 1 day in each group. Median dysphagia scores decreased from 4 (0–5) to 1 (0–4) following primary POEM and 4 (0–5) to 0 (0–4) in the prior treatment group (p = 0.45) during a median follow-up of 10 months (5–17 months). All patients in each group expressed satisfaction with their procedure and would undergo the procedure again given the benefit of hindsight.

Conclusion

Per-oral endoscopic myotomy is a safe and effective treatment for achalasia which improves dysphagia and disease-specific quality of life. Previous endoscopic or laparoscopic treatment of achalasia does not affect the performance or early outcome of POEM.

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Title: Prior treatment does not influence the performance or early outcome of per-oral endoscopic myotomy for achalasia
Authors: Edward L. Jones
Michael P. Meara
Matthew R. Pittman
Jeffrey W. Hazey
Kyle A. Perry
Publication date: 01-04-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 4/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4339-y

At a glance: The STEP trials

Springer Medicine

Prior treatment does not influence the performance or early outcome of per-oral endoscopic myotomy for achalasia

Abstract

Introduction

Methods and Procedures

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods and Procedures

Results

Conclusion

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