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Surgical Endoscopy
Published in: Surgical Endoscopy 6/2016

Open Access 01-06-2016

A prospective analysis of GERD after POEM on anterior myotomy

Authors: Hironari Shiwaku, Haruhiro Inoue, Takamitsu Sasaki, Kanefumi Yamashita, Toshihiro Ohmiya, Shinsuke Takeno, Satoshi Nimura, Yuichi Yamashita

Published in: Surgical Endoscopy | Issue 6/2016

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Abstract

Background

Peroral endoscopic myotomy (POEM) is an emerging, minimally invasive procedure capable of overcoming limitations of achalasia treatments, but gastroesophageal reflux disease (GERD) after POEM is of concern and its risk factors have not been evaluated. This prospective study examined GERD and the association of POEM with reflux esophagitis.

Methods

Achalasia patients were recruited from a single center. The pre- and postoperative assessments included Eckardt scores, manometry, endoscopy, and pH monitoring.

Results

Between September 2011 and November 2014, 105 patients underwent POEM; 70 patients were followed up 3 months after POEM. Postoperatively, significant reductions were observed in lower esophageal sphincter (LES) pressure [from 40.0 ± 22.8 to 20.7 ± 14.0 mmHg (P < 0.05)], LES residual pressure [from 22.1 ± 13.3 to 11.4 ± 6.6 mmHg (P < 0.05)], and Eckardt scores [from 5.7 ± 2.5 to 0.7 ± 0.8 (P < 0.05)]. Symptomatic GERD and moderate reflux esophagitis developed in 5 and 11 patients (grade B, n = 8; grade C, n = 3), respectively, and were well controlled with proton pump inhibitors. Univariate logistic regression analysis revealed integrated relaxation pressure was a predictor of ≥grade B reflux esophagitis. No POEM factors were found to be associated with reflux esophagitis.

Conclusion

POEM is effective and safe in treating achalasia, with no occurrence of clinically significant refractory GERD. Myotomy during POEM, especially of the gastric side, was not associated with ≥grade B (requiring medical intervention) reflux esophagitis. Extended gastric myotomy (2–3 cm) during POEM is recommended to improve outcomes.
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Metadata
Title
A prospective analysis of GERD after POEM on anterior myotomy
Authors
Hironari Shiwaku
Haruhiro Inoue
Takamitsu Sasaki
Kanefumi Yamashita
Toshihiro Ohmiya
Shinsuke Takeno
Satoshi Nimura
Yuichi Yamashita
Publication date
01-06-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 6/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4507-0

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