Peroral endoscopic myotomy as salvation technique post‐Heller: International experience |
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| Authors: | Amy Tyberg Reem Z. Sharaiha Pietro Familiari Guido Costamagna Fernando Casas Nikhil A. Kumta Maximilien Barret Amit P. Desai Felice Schnoll‐Sussman Payal Saxena Guadalupe Martínez Felipe Zamarripa Monica Gaidhane Helga Bertani Peter V. Draganov Valerio Balassone Ahmed Sharata Kevin Reavis Lee Swanstrom Martina Invernizzi Stefan Seewald Hitomi Minami Haruhiro Inoue Michel Kahaleh |
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| Affiliation: | 1. Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, USA;2. Digestive Endoscopy Unit, Catholic University, Rome, Italy;3. Gastroenterology, Bogota General Hospital, Bogota, Colombia;4. Gastroenterology, Pompidou Clinic, Paris, France;5. Gastroenterology, Johns Hopkins, Baltimore, USA;6. Gastroenterology, Juarez Hospital, Mexico City, Mexico;7. Gastroenterology, Locale Modena, Modena, Italy;8. Gastroenterology, Gainesvillle Medical Center, Gainesville, USA;9. Gastroenterology, Showa University Northern Yokohama Hospital, Tokyo, Japan;10. Gastroenterology, Oregon Clinic, Portland, USA;11. Gastroenterology, Portland Clinic, Portland, USA;12. Gastroenterology, Klinik Hirslanden, Zurich, Switzerland;13. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan |
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| Abstract: | Background Treatment for achalasia has traditionally been Heller myotomy (HM). Despite its excellent efficacy rate, a number of patients remain symptomatic post‐procedure. Limited data exist as to the best management for recurrence of symptoms post‐HM. We present an international, multicenter experience evaluating the efficacy and safety of post‐HM peroral endoscopic myotomy (POEM). Methods Patients who underwent POEM post‐HM from 13 centers from January 2012 to January 2017 were included as part of a prospective registry. Technical success was defined as successful completion of the myotomy. Clinical success was defined as an Eckardt score of ≤3 on 12‐month follow up. Adverse events (AE) including anesthesia‐related, operative, and postoperative complications were recorded. Results Fifty‐one patients were included in the study (mean age 54.2, 47% male). Technical success was achieved in 100% of patients. Clinical success on long‐term follow up was achieved in 48 patients (94%), with a mean change in Eckardt score of 6.25. Seven patients (13%) had AE: six experienced periprocedural mucosal defect treated endoscopically and two patients developed mediastinitis treated conservatively. Conclusion For patients with persistent symptoms after HM, POEM is a safe salvation technique with good short‐term efficacy. As a result of the challenge associated with repeat HM, POEM might become the preferred technique in this patient population. Further studies with longer follow up are needed. |
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| Keywords: | achalasia endoscopy esophagus Heller myotomy peroral endoscopic myotomy (POEM) |
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