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Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years
  1. Yuki B Werner1,2,
  2. Guido Costamagna3,
  3. Lee L Swanström4,
  4. Daniel von Renteln1,5,
  5. Pietro Familiari3,
  6. Ahmed M Sharata4,
  7. Tania Noder1,
  8. Guido Schachschal1,
  9. Jan F Kersten6,
  10. Thomas Rösch1
  1. 1Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  2. 2Department of Gastroenterology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  3. 3Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
  4. 4Providence Cancer Center, Portland, Oregon, USA
  5. 5Department of Gastroenterology, Centre Hospitalier de L'Université de Montreal, Montreal, Quebec, Canada
  6. 6Department of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  1. Correspondence to Dr Thomas Rösch, Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany; t.roesch{at}uke.de

Abstract

Background The recently developed technique for peroral endoscopic myotomy (POEM) has been shown to be effective in several short-term studies. Longer term outcome data are largely non-existent.

Objective To systematically report clinical outcome with a minimum post-POEM follow-up of 2 years.

Design All patients treated consecutively by POEM for achalasia at three centres were retrospectively analysed, with a minimum follow-up of 2 years. The main outcome was the rate of POEM failures (Eckardt score >3) related to follow-up time.

Results Of 85 patients treated, five (5.9%) cases were excluded due to protocol violation or loss to follow-up; the remaining 80 patients (mean age 44.9 years, 54% men) were followed clinically for 29 months (range 24–41). Initial clinical response was observed in 77 cases (96.3%). Clinical recurrences (later failures) were seen in a further 14 cases (17.7%), accounting for a total failure rate of 21.5%. In a multivariate analysis, age and endoscopic reflux signs were independent predictors of treatment success. Of the 17 failures, eight were among the first 10 cases treated in the participating centres. Reflux-associated sequelae included one case of a severe reflux-associated stricture requiring dilatation, and two patients with minor transient Eckardt score elevations curable by proton pump inhibitor (PPI) treatment. Endoscopic signs of reflux oesophagitis, mostly Los Angeles grade A/B, were seen in 37.5% (37/72) at the 2-year control.

Conclusions In this multicentre retrospective analysis, a high initial success rate of POEM is followed by a mid-term recurrence rate of 18%. Reflux oesophagitis, albeit mild, is frequent and should probably be treated by regular low-dose PPI therapy.

Trial registration number NCT 01405417 (UKE study).

  • ACHALASIA
  • ENDOSCOPY

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