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Predictors of Long-Term Outcomes, Recurrent Dysphagia, and Gastroesophageal Reflux After Per-oral Endoscopic Myotomy in Esophageal Motility Disorders

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

There is limited data on long-term outcomes of per-oral endoscopic myotomy (POEM). In this study, we aim to evaluate the efficacy of POEM in patients who completed a minimum follow-up of 5 years.

Methods

Data of patients who underwent POEM and completed ≥ 5-year follow-up were analyzed, retrospectively. Primary outcome of study was clinical success (Eckardt ≤ 3) at ≥ 5 years after POEM. Secondary outcomes included predictors of dysphagia and symptomatic gastroesophageal reflux disease (GERD) on long-term follow-up.

Results

Three hundred nineteen patients (males 182, mean age 40.5 ± 14.2 years) completed a median of 73-(60–89) month follow-up. Esophageal motility disorders included idiopathic achalasia (type I 26.6%, type II 60.8%, type III 5.6%) and Jackhammer esophagus or distal esophageal spasm (2.8%). POEM was technically successful in 307 (96.2%) patients. Long-term success was 92.6% (overall), 92.1% (type I), 94.7% (type II), 87.5% (type III), and 75% (Jackhammer esophagus/distal esophageal spasm). Symptomatic GERD and reflux esophagitis were detected in 28.9% and 35.3% patients, respectively. On multivariate analysis, young age and female gender were independent risk factors for recurrent dysphagia (p = 0.037) and symptomatic GERD after POEM (p = 0.025), respectively. Lower post-POEM lower esophageal sphincter pressure was an independent predictor for reflux esophagitis (p = 0.016).

Conclusion

POEM is an effective and durable treatment for achalasia and non-achalasia spastic motility disorders. Young patients and females may be at higher risk for recurrent dysphagia and symptomatic GERD, respectively.

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Data Availability

The original anonymous dataset is available on request from the corresponding author at zaheernabi1978@gmail.com.

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Authors and Affiliations

  1. Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India

    Zaheer Nabi, Arun Karyampudi, Mohan Ramchandani, Radhika Chavan, Jahangeer Basha, Pradev Inavolu, Santosh Darisetty, Rajesh Goud & D. Nageshwar Reddy

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  1. Zaheer Nabi
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  2. Arun Karyampudi
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  3. Mohan Ramchandani
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  4. Radhika Chavan
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  9. D. Nageshwar Reddy
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Contributions

Zaheer Nabi, Pradev Inavolu, and Mohan Ramchandani were involved in conception of the study. Jahangeer Basha, Rajesh Goud, and Radhika Chavan were involved in acquisition and analysis of the data. Arun Karyampudi, Santosh Darisetty, and D. Nageshwar Reddy were involved in revising the manuscript for important intellectual content. All the authors agreed to the final version of the manuscript.

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Correspondence to Zaheer Nabi.

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Nabi, Z., Karyampudi, A., Ramchandani, M. et al. Predictors of Long-Term Outcomes, Recurrent Dysphagia, and Gastroesophageal Reflux After Per-oral Endoscopic Myotomy in Esophageal Motility Disorders. J Gastrointest Surg 26, 1352–1361 (2022). https://doi.org/10.1007/s11605-022-05330-z

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