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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(11): E1595-E1601
DOI: 10.1055/a-1553-9846
Original article

Durability of per-oral endoscopic myotomy beyond 6 years

Jad P. AbiMansour
1   Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
,
Yervant Ichkhanian
1   Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
,
Hitomi Minami
2   Department of Gastroenterology and Hepatology Nagasaki University Hospital Nagasaki, Japan
,
Pietro Familiari
3   Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome, Italy
,
Rosario Landi
3   Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome, Italy
,
Guido Costamagna
3   Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome, Italy
,
Stefan Seewald
4   Center of Gastroenterology Hirslanden Private Clinic Group Zürich, Switzerland
,
Zachary M. Callahan
5   Department of Surgery NorthShore University HealthSystem Evanston, USA
,
Michael B. Ujiki
5   Department of Surgery NorthShore University HealthSystem Evanston, USA
,
Mathieu Pioche
6   Gastroenterology Unit/Unit of Functional Disease and Digestive Physiology Edouard Herriot Hospital Lyon, France
,
Thierry Ponchon
6   Gastroenterology Unit/Unit of Functional Disease and Digestive Physiology Edouard Herriot Hospital Lyon, France
,
Sabine Roman
6   Gastroenterology Unit/Unit of Functional Disease and Digestive Physiology Edouard Herriot Hospital Lyon, France
,
Joo Young Cho
7   Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, Korea
,
In Kyung Yoo
7   Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, Korea
,
Megan Sippey
8   Case Western/University Hospitals Cleveland Medical Center, Cleveland, USA
,
Jeffrey M. Marks
8   Case Western/University Hospitals Cleveland Medical Center, Cleveland, USA
,
Nikolas Eleftheriadis
9   Metropolitan Hospital, Athens, Greece
,
Vivek Khumbari
1   Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
,
Olaya I. Brewer Gutierrez
1   Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
,
Mouen A. Khashab
1   Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
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Abstract

Background and study aims The aim of this study was to assess long-term clinical outcomes beyond 6 years in patients who underwent per-oral endoscopic myotomy (POEM) for the treatment of achalasia.

Patients and methods Patients with achalasia who underwent POEM between 2010 and 2012 and had follow-up of at least 6 years were retrospectively identified at eight tertiary care centers. The primary outcome evaluated was clinical success defined by an Eckardt symptom score (ESS) ≤ 3 for the duration of the follow-up period. The clinical success cohort was compared to failure (ESS > 3 at any time during follow-up) in order to identify characteristics associated with symptom relapse. The incidence of patient-reported gastroesophageal reflux (GER) was also evaluated.

Results Seventy-three patients with 6-year follow-up data were identified. Sustained clinical remission was noted in 89 % (65/73) at 6-years. Mean ESS decreased from 7.1 ± 2.3 pre-procedure to 1.1 ± 1.1 at 6 years (P < 0.001). Symptomatic reflux was reported by 27 of 72 patients (37.5 %). Type I achalasia (OR 10.8, P = 0.04) was found to be associated with clinical failure on logistic regression analysis.

Conclusions In patients with achalasia, POEM provides high initial clinical success with excellent long-term outcomes. There are high rates of patient-reported gastroesophageal reflux post-procedure which persist at long-term follow-up.



Publication History

Received: 03 August 2020

Accepted: 26 April 2021

Article published online:
12 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
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