Efficacy and Safety of Peroral Endoscopic Myotomy for Treatment of Achalasia after Failed Heller Myotomy.

Efficacy and Safety of Peroral Endoscopic Myotomy for Treatment of Achalasia after Failed Heller Myotomy.

Clin Gastroenterol Hepatol. 2017 Feb 09;:

Authors: Ngamruengphong S, Inoue H, Ujiki MB, Patel LY, Bapaye A, Desai PN, Dorwat S, Nakamura J, Hata Y, Balassone V, Onimaru M, Ponchon T, Pioche M, Roman S, Rivory J, Mion F, Garros A, Draganov PV, Perbtani Y, Abbas A, Pannu D, Yang D, Perretta S, Romanelli J, Desilets D, Hayee B, Haji A, Hajiyeva G, Ismail A, Chen YI, Bukhari M, Haito-Chavez Y, Kumbhari V, Saxena P, Talbot M, Chiu PW, Yip HC, Wong VW, Hernaez R, Maselli R, Repici A, Khashab MA

Abstract
BACKGROUND & AIMS: In patients with persistent symptoms after Heller myotomy (HM), treatment options include repeat HM, pneumatic dilation, or peroral endoscopic myotomy (POEM). We evaluated the efficacy and safety of POEM in patients with achalasia with prior HM vs without prior HM.
METHODS: We conducted a retrospective cohort study of 180 patients with achalasia who underwent POEM at 13 tertiary centers worldwide, from December 2009 through September 2015. Patients were divided into 2 groups: those with prior HM (HM group, exposure, n=90) and those without prior HM (non-HM group, n=90). Clinical response was defined by decrease in Eckardt scores to 3 or less. Adverse events were graded according to criteria set by the American Society for Gastrointestinal Endoscopy. Technical success, clinical success, and rates of adverse events were compared between groups. Patients were followed for a median time of 8.5 months.
RESULTS: POEM was technically successful in 98% of patients in the HM group and 100% of patients in the non-HM group (P=.49). A significantly lower proportion of patients in the HM group had a clinical response to POEM (81%) than in the non-HM group (94%; P=.01). There were no significant differences in rates of adverse events between the groups (8% in HM group vs 13% in non-HM group; P=.23). Symptomatic reflux and reflux esophagitis after POEM were comparable between groups.
CONCLUSION: POEM is safe and effective for patients with achalasia not successfully treated by prior HM. Although rate of clinical success in patients with prior HM is lower than those without prior HM, the safety profile of POEM is comparable between groups.

PMID: 28189695 [PubMed - as supplied by publisher]

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