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01-03-2018

Per-oral endoscopic myotomy (POEM): mid-term efficacy and safety

Authors: Jan Martinek, Hana Svecova, Zuzana Vackova, Radek Dolezel, Ondrej Ngo, Jana Krajciova, Eva Kieslichova, Radim Janousek, Alexander Pazdro, Tomas Harustiak, Lucie Zdrhova, Pavla Loudova, Petr Stirand, Julius Spicak

Published in: Surgical Endoscopy | Issue 3/2018

Abstract

Background and aims

Per-oral endoscopic myotomy (POEM) is becoming a standard treatment for achalasia. Long-term efficacy and the rate of post-POEM reflux should be further investigated. The main aim of this study was to analyze safety and mid-term (12 and 24 months) clinical outcomes of POEM.

Methods

Data on single tertiary center procedures were collected prospectively. The primary outcome was treatment success defined as an Eckardt score < 3 at 12 and 24 months. A total of 155 consecutive patients with achalasia underwent POEM; 133 patients were included into the analysis (22 patients will be analyzed separately as part of a multicenter randomized clinical trial).

Results

POEM was successfully completed in 132 (99.2%) patients, and the mean length of the procedure was 69.8 min (range 31–136). One patient underwent a drainage for pleural effusion; no other serious adverse events occurred. Treatment success at 3, 12, and 24 months was observed in 95.5% (CI 89.6–98.1), 93.4% (86.5–96.8), and 84.0% (71.4–91.4) of patients, respectively. A total of 11 patients (8.3%) reported initial treatment failure (n = 5) or later recurrence (n = 6). The majority of relapses occurred in patients with achalasia type I (16.7 vs. 1.1% achalasia type II vs. 0% achalasia type III; p<0.05). At 12 months, post-POEM reflux symptoms were present in 29.7% of patients. At 3 months, mild reflux esophagitis was diagnosed in 37.6% of patients, and pathological gastroesophageal reflux was detected in 41.5% of patients. A total of 37.8% of patients had been treated with a proton pump inhibitor.

Conclusion

POEM resulted in greater than 90% treatment success at 12 months which tends to decrease to 84% after 2 years. More than one-third of the patients had mild reflux symptoms and/or mild esophagitis.

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Title: Per-oral endoscopic myotomy (POEM): mid-term efficacy and safety
Authors: Jan Martinek
Hana Svecova
Zuzana Vackova
Radek Dolezel
Ondrej Ngo
Jana Krajciova
Eva Kieslichova
Radim Janousek
Alexander Pazdro
Tomas Harustiak
Lucie Zdrhova
Pavla Loudova
Petr Stirand
Julius Spicak
Publication date: 01-03-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 3/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5807-3

At a glance: The STEP trials

Springer Medicine

Per-oral endoscopic myotomy (POEM): mid-term efficacy and safety

Abstract

Background and aims

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background and aims

Methods

Results

Conclusion

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