Skip to main content
SpringerLink
Log in

POEM: clinical outcomes beyond 5 years

  • 2020 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The short-term success of peroral endoscopic myotomy (POEM) is well documented but the durability of the operation is questioned. The aim of this study was to evaluate the clinical outcomes of the POEM procedure for esophageal motility disorders in a large cohort in which all patients had at least 5 years of follow-up.

Methods

All patients from a single center who underwent a POEM between October 2010 and September 2014 were followed for long-term clinical outcomes. Postoperative Eckardt symptom scores of short term and ≥ 5 years were collected through phone interview. Clinical success was defined as an Eckardt score < 3. Overall success was defined as Eckardt score < 3 and freedom from additional interventions.

Results

Of 138 patients, 100 patients were available for follow-up (mean age 56, 52% male). The indication for operation was achalasia in 94. The mean follow-up duration was 75 months (range: 60–106 months). Dysphagia was improved in 91% of patients. Long-term overall success was achieved in 79% of patients (80% of achalasia patients, 67% of DES patients). Preoperative mean Eckardt score was 6. At 6 months, it was 1, and at 75 months, it was 2 (p = 0.204). Five-year freedom from intervention was 96%. Overall, 7 patients had additional treatments: 1 balloon dilation (35 mm), 4 laparoscopic Heller myotomy, and 2 redo POEM at a mean of 51 months post-POEM. Ninety-three percent expressed complete satisfaction with POEM.

Conclusion

A multitude of studies has shown the early benefits of POEM. Here, we show that nearly 80% of patients report clinical success with no significant decrement in symptom scores between their short- and long-term follow-up. Clearly POEM is an effective option for achalasia with durable long-term treatment efficacy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H (2010) Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42(4):265–271. https://doi.org/10.1055/s-0029-1244080

    Article  CAS  PubMed  Google Scholar 

  2. Inoue H, Sato H, Ikeda H et al (2015) Per-oral endoscopic myotomy: a series of 500 patients. J Am Coll Surg 221:256–264. https://doi.org/10.1016/j.jamcollsurg.2015.03.057

    Article  PubMed  Google Scholar 

  3. Costamagna G, Marchese M, Familiari P, Tringali A, Inoue H, Perri V (2012) Peroral endoscopic myotomy (POEM) for oesophageal achalasia: preliminary results in humans. Dig Liver Dis 44(10):827–32

    Article  Google Scholar 

  4. Sharata AM, Dunst CM, Pescarus R et al (2014) Peroral endoscopic myotomy (POEM) for esophageal primary motility disorders: analysis of 100 consecutive patients. J Gastrointest Surg 19(1):161–170. https://doi.org/10.1007/s11605-014-2610-5

    Article  PubMed  Google Scholar 

  5. Werner YB, Hakanson B, Martinek J, Repici A, Rahden BHV, Bredenoord AJ (2019) Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. N Engl J Med 381(23):2219–2229. https://doi.org/10.1056/nejmoa1905380

    Article  PubMed  Google Scholar 

  6. Hungness ES, Sternbach JM, Teitelbaum EN, Kahrilas PJ, Pandolfino JE, Soper NJ (2016) Per-oral endoscopic myotomy (POEM) after the learning curve: durable long-term results with a low complication rate. Ann Surg 264(3):508–17

    Article  Google Scholar 

  7. Brewer Gutierrez OI, Moran RA, Familiari P et al (2020) Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study. Endosc Int Open 8(5):E650–E655. https://doi.org/10.1055/a-1120-8125

    Article  PubMed  PubMed Central  Google Scholar 

  8. Li QL, Wu QN, Zhang XC, Xu MD, Zhang W, Chen SY et al (2018) Outcomes of per-oral endoscopic myotomy for treatment of esophageal achalasia with a median follow-up of 49 months. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2017.10.031

    Article  PubMed  PubMed Central  Google Scholar 

  9. Podboy AJ, Hwang JH, Rivas H et al (2020) Long-term outcomes of per-oral endoscopic myotomy compared to laparoscopic Heller myotomy for achalasia: a single-center experience. Surg Endosc. https://doi.org/10.1007/s00464-020-07450-6

    Article  PubMed  Google Scholar 

  10. Teitelbaum EN, Dunst CM, Reavis KM, Sharata AM, Ward MA, Demeester SR, Swanström LL (2017) Clinical outcomes five years after POEM for treatment of primary esophageal motility disorders. Surg Endosc 32(1):421–427. https://doi.org/10.1007/s00464-017-5699-2

    Article  PubMed  Google Scholar 

  11. Repici A, Fuccio L, Maselli R, Mazza F, Correale L, Mandolesi D, Bellisario C, Sethi A, Khashab MA, Rösch T, Hassan C (2018) GERD after per-oral endoscopic myotomy as compared with Heller’s myotomy with fundoplication: a systematic review with meta-analysis. Gastrointest Endosc 87(4):934–43

    Article  Google Scholar 

  12. Filicori F, Dunst CM, Sharata A, Abdelmoaty WF, Zihni AM, Reavis KM et al (2018) Long-term outcomes following POEM for non-achalasia motility disorders of the esophagus. Surg Endosc 33(5):1632–1639. https://doi.org/10.1007/s00464-018-6438-z

    Article  PubMed  Google Scholar 

  13. Eckardt VF, Aignherr C, Bernhard G (1992) Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 103(6):1732–1738. https://doi.org/10.1053/j.gastro.2008.07.022.Achalasia

    Article  CAS  PubMed  Google Scholar 

  14. Boeckxstaens GE, Annese V, des Varannes SB et al (2011) Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 364(19):1807–16

    Article  CAS  Google Scholar 

  15. Kahrilas PJ, Bredenoord AJ, Fox M et al (2015) The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 27(2):160–174

    Article  CAS  Google Scholar 

  16. Sharata A, Kurian AA, Dunst CM, Bhayani NH, Reavis KM, Swanstrom LL (2014) Technique of per-oral endoscopic myotomy (POEM) of the esophagus (with video). Surg Endosc Other Interv Tech 28(4):1333. https://doi.org/10.1007/s00464-013-3332-6

    Article  Google Scholar 

  17. Stavropoulos SN, Modayil RJ, Friedel D, Savides T (2013) The International Per Oral Endoscopic Myotomy Survey (IPOEMS): a snapshot of the global POEM experience. Surg Endosc 27(9):3322–3338. https://doi.org/10.1007/s00464-013-2913-8

    Article  PubMed  Google Scholar 

  18. Von Renteln D, Fuchs KH, Fockens P et al (2013) Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology 145(2):309–11

    Article  Google Scholar 

  19. Moonen A, Annese V, Belmans A et al (2016) Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut 65:732–739. https://doi.org/10.1136/gutjnl-2015-310602

    Article  PubMed  Google Scholar 

  20. Costantino CL, Geller AD, Visenio MR, Morse CR, Rattner DW (2020) Outcomes of laparoscopic heller myotomy for achalasia: 22-year experience. J Gastrointest Surg 24(6):1411–1416. https://doi.org/10.1007/s11605-020-04586-7

    Article  PubMed  Google Scholar 

  21. Scherer JR, Kwiatek MA, Soper NJ, Pandolfino JE, Kahrilas PJ (2009) Functional esophagogastric junction obstruction with intact peristalsis: a heterogeneous syndrome sometimes akin to achalasia. J Gastrointest Surg 13(12):2219–2225. https://doi.org/10.1007/s11605-009-0975-7

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tamhankar AP, Almogy G, Arain MA et al (2003) Surgical management of hypertensive lower esophageal sphincter with dysphagia or chest pain. J Gastrointest Surg 7:990–996. https://doi.org/10.1016/j.gassur.2003.09.003

    Article  PubMed  Google Scholar 

  23. Krishnamohan P, Allen MS, Shen KR, Wigle DA, Nichols FC, Cassivi SD et al (2014) Long-term outcome after laparoscopic myotomy for achalasia. J Thorac Cardiovasc Surg 147(2):730–737. https://doi.org/10.1016/j.jtcvs.2013.09.063

    Article  PubMed  Google Scholar 

  24. Khajanchee YS, Kanneganti S, Leatherwood AE, Hansen PD, Swanström LL (2005) Laparoscopic Heller myotomy with Toupet fundoplication: outcomes predictors in 121 consecutive patients. Arch Surg 140(9):827–33 discussion 833–4

    Article  Google Scholar 

  25. Rawlings A, Soper NJ, Oelschlager B, Swanstrom L, Matthews BD, Pellegrini C, Pierce RA, Pryor A, Martin V, Frisella MM, Cassera M, Brunt LM (2012) Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc 26(1):18–26. https://doi.org/10.1007/s00464-011-1822-y

    Article  PubMed  Google Scholar 

  26. Oelschlager BK, Lal DR, Jensen EA, Cahill M, Quiroga E, Pellegrini C (2006) Medium- and long-term outcome of laparoscopic redo fundoplication. Surg Endosc 20(12):1817–1823. https://doi.org/10.1007/s00464-005-0262-y

    Article  CAS  PubMed  Google Scholar 

  27. Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW (2004) Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg 240(3):405–12 discussion 412–5

    Article  Google Scholar 

  28. Jones EL, Meara MP, Schwartz JS, Hazey JW, Perry KA (2015) Gastroesophageal reflux symptoms do not correlate with objective pH testing after peroral endoscopic myotomy. Surg Endosc 30(3):947–952. https://doi.org/10.1007/s00464-015-4321-8

    Article  PubMed  Google Scholar 

  29. Kurian AA, Dunst CM, Sharata A, Bhayani NH, Reavis KM, Swanström LL (2013) Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc 77(5):719–725. https://doi.org/10.1016/j.gie.2012.12.006

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Kelly M Reavis, PhD, for statistical support.

Author information

Authors and Affiliations

  1. Foundation for Surgical Innovation and Education, Portland, OR, USA

    Sarah C. McKay, Christy M. Dunst, Ahmed M. Sharata, Reid Fletcher, Kevin M. Reavis, Daniel Davila Bradley, Steven R. DeMeester, Dolores Müller, Brett Parker & Lee L. Swanström

  2. The Oregon Clinic: Gastrointestinal and Minimally Invasive Surgery Division, Portland, OR, USA

    Christy M. Dunst, Kevin M. Reavis, Daniel Davila Bradley & Steven R. DeMeester

  3. Providence Portland Medical Center, 4805 NE Glisan Ave, Portland, OR, 97213, USA

    Christy M. Dunst, Ahmed M. Sharata, Reid Fletcher, Kevin M. Reavis, Daniel Davila Bradley & Brett Parker

  4. IHU Strasbourg, Strasbourg, France

    Lee L. Swanström

Authors
  1. Sarah C. McKay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christy M. Dunst
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmed M. Sharata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Reid Fletcher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kevin M. Reavis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniel Davila Bradley
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Steven R. DeMeester
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dolores Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Brett Parker
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lee L. Swanström
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christy M. Dunst.

Ethics declarations

Disclosures

Drs. McKay, Sharata, Fletcher, Davila Bradley, Reavis, and Parker have no disclosures or conflicts of interest to report. Dr Dunst is a consultant for Bard. Dr. DeMeester is a consultant for Bard. Dr Müller receives research support from Restech. Dr. Swanström is on the scientific advisory boards of Olympus, Medtronic and Boston Scientific. These disclosures are not related to the current study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 20 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McKay, S.C., Dunst, C.M., Sharata, A.M. et al. POEM: clinical outcomes beyond 5 years. Surg Endosc 35, 5709–5716 (2021). https://doi.org/10.1007/s00464-020-08031-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-08031-3

Keywords

Search

Navigation