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Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for treatment of achalasia.
Surg Endosc. 2014 Dec; 28(12):3359-65.SE

Abstract

BACKGROUND

Peroral esophageal myotomy (POEM) is a new endoscopic operation for the treatment of achalasia. Here, we report 1-year physiologic and symptomatic outcomes following the procedure.

METHODS

POEM patients from a single-institution series who were more than 1 year removed from surgery were studied. Eckardt and GerdQ scores were obtained to assess symptoms. High-resolution manometry (HRM), timed barium esophagram (TBE), and upper endoscopy were preformed preoperatively and at 1-year follow-up. 24-h pH monitoring was also performed at 1 year follow-up.

RESULTS

The study population was comprised of 41 patients who were more than 1 year post-POEM. One (2%) major complication, a contained leak at the EGJ requiring re-operation, and 7 (17%) minor complications occurred. Mean length of stay was 1.4 days. At mean 15-month follow-up, Eckardt scores improved from pre-POEM 7 ± 2 to post-POEM 1 ± 2, (scale 0-12, p < .001), and 92% of patients achieved treatment success (Eckardt score <4). Two of the three treatment failures in the series occurred in the initial three patients. 15% of patients had post-POEM symptoms suggestive of gastroesophageal reflux (GerdQ >7). On follow-up HRM, esophagogastric junction integrated relaxation pressure was decreased significantly (pre-POEM 28 ± 12 mmHg vs. post-POEM 11 ± 4 mmHg, p < .001), and 47% of patients studied had partial recovery of peristalsis. On follow-up TBE, barium column heights were decreased compared with preoperatively. Postoperative upper endoscopy revealed esophagitis in 59% of patients (11 LA Grade A, 2 LA Grade D). However, of the 13 24-h pH monitoring studies performed, only four (31%) demonstrated pathologic esophageal acid exposure.

CONCLUSIONS

In this series, POEM resulted in greater than 90% symptomatic treatment success at mean 15-month follow-up. Rates of iatrogenic gastroesophageal reflux, as measured both by symptoms and 24-h pH monitoring, appeared to be on par with recent studies of patients undergoing laparoscopic Heller myotomy and pneumatic dilation.

Authors+Show Affiliations

Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Chicago, IL, 60611, USA, ezratei@gmail.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

24939164

Citation

Teitelbaum, Ezra N., et al. "Symptomatic and Physiologic Outcomes One Year After Peroral Esophageal Myotomy (POEM) for Treatment of Achalasia." Surgical Endoscopy, vol. 28, no. 12, 2014, pp. 3359-65.
Teitelbaum EN, Soper NJ, Santos BF, et al. Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for treatment of achalasia. Surg Endosc. 2014;28(12):3359-65.
Teitelbaum, E. N., Soper, N. J., Santos, B. F., Arafat, F. O., Pandolfino, J. E., Kahrilas, P. J., Hirano, I., & Hungness, E. S. (2014). Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for treatment of achalasia. Surgical Endoscopy, 28(12), 3359-65. https://doi.org/10.1007/s00464-014-3628-1
Teitelbaum EN, et al. Symptomatic and Physiologic Outcomes One Year After Peroral Esophageal Myotomy (POEM) for Treatment of Achalasia. Surg Endosc. 2014;28(12):3359-65. PubMed PMID: 24939164.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for treatment of achalasia. AU - Teitelbaum,Ezra N, AU - Soper,Nathaniel J, AU - Santos,Byron F, AU - Arafat,Fahd O, AU - Pandolfino,John E, AU - Kahrilas,Peter J, AU - Hirano,Ikuo, AU - Hungness,Eric S, Y1 - 2014/06/18/ PY - 2014/03/29/received PY - 2014/05/16/accepted PY - 2014/6/19/entrez PY - 2014/6/19/pubmed PY - 2015/6/24/medline SP - 3359 EP - 65 JF - Surgical endoscopy JO - Surg Endosc VL - 28 IS - 12 N2 - BACKGROUND: Peroral esophageal myotomy (POEM) is a new endoscopic operation for the treatment of achalasia. Here, we report 1-year physiologic and symptomatic outcomes following the procedure. METHODS: POEM patients from a single-institution series who were more than 1 year removed from surgery were studied. Eckardt and GerdQ scores were obtained to assess symptoms. High-resolution manometry (HRM), timed barium esophagram (TBE), and upper endoscopy were preformed preoperatively and at 1-year follow-up. 24-h pH monitoring was also performed at 1 year follow-up. RESULTS: The study population was comprised of 41 patients who were more than 1 year post-POEM. One (2%) major complication, a contained leak at the EGJ requiring re-operation, and 7 (17%) minor complications occurred. Mean length of stay was 1.4 days. At mean 15-month follow-up, Eckardt scores improved from pre-POEM 7 ± 2 to post-POEM 1 ± 2, (scale 0-12, p < .001), and 92% of patients achieved treatment success (Eckardt score <4). Two of the three treatment failures in the series occurred in the initial three patients. 15% of patients had post-POEM symptoms suggestive of gastroesophageal reflux (GerdQ >7). On follow-up HRM, esophagogastric junction integrated relaxation pressure was decreased significantly (pre-POEM 28 ± 12 mmHg vs. post-POEM 11 ± 4 mmHg, p < .001), and 47% of patients studied had partial recovery of peristalsis. On follow-up TBE, barium column heights were decreased compared with preoperatively. Postoperative upper endoscopy revealed esophagitis in 59% of patients (11 LA Grade A, 2 LA Grade D). However, of the 13 24-h pH monitoring studies performed, only four (31%) demonstrated pathologic esophageal acid exposure. CONCLUSIONS: In this series, POEM resulted in greater than 90% symptomatic treatment success at mean 15-month follow-up. Rates of iatrogenic gastroesophageal reflux, as measured both by symptoms and 24-h pH monitoring, appeared to be on par with recent studies of patients undergoing laparoscopic Heller myotomy and pneumatic dilation. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/24939164/Symptomatic_and_physiologic_outcomes_one_year_after_peroral_esophageal_myotomy__POEM__for_treatment_of_achalasia_ L2 - https://dx.doi.org/10.1007/s00464-014-3628-1 DB - PRIME DP - Unbound Medicine ER -