Advertisement

Surgical Endoscopy

, Volume 31, Issue 4, pp 1550–1557 | Cite as

Outcomes in patients with over 1-year follow-up after peroral endoscopic myotomy (POEM)

  • Marc A. WardEmail author
  • Matt Gitelis
  • Lava Patel
  • Yalini Vigneswaran
  • Joann Carbray
  • Michael B. Ujiki
Article

Abstract

Background

Peroral endoscopic myotomy (POEM) is a promising therapy in the treatment of achalasia. The study was designed to report outcomes, including quality of life, in patients with at least 1-year follow-up.

Methods

Patients from an institutional review board-approved protocol underwent POEM and were followed prospectively. Health-related quality of life was measured preoperatively and 1 year post-operatively using Short Form-36 Health Survey version 2 (SF-36v2). Comparisons were made with patients from a prospective database who underwent laparoscopic Heller myotomy (LHM) over the same period. Paired t tests were used to analyze all normally distributed data, while Wilcoxon signed-rank tests were used to analyze SF-36 data, as it does not follow a normal distribution.

Results

We analyzed 41 consecutive POEM patients with at least 1-year follow-up. Significant improvements in quality of life between baseline and 1 year were found in role limitations due to physical health (81.8 ± 25.8 vs. 65.9 ± 31.6, p = 0.01) and social functioning (83 ± 19.1 vs. 64.6 ± 31.3, p = 0.01). When compared to 24 patients who underwent LHM, there was no difference in average Eckardt scores (0.9 ± 1.6 vs. 1.0 ± 1.3, p > 0.05) or incidence of PPI use (43.5 vs. 47.5 %, p = 0.71). However, when looking at just type III patients, POEM patients had a higher remission rate (100 vs. 62.5 %) and significantly lower post-operative Eckardt scores at 1 year (1.1 vs. 3.1, p < 0.05). The average myotomy length of type III achalasia patients undergoing POEM was 18.6 cm (±6.9) compared to 10.3 cm (±1.0) in LHM patients (p < 0.01), which may have contributed to this difference.

Conclusion

POEM provides a significant quality of life benefit at 1 year while having similar relief of dysphagia and post-operative PPI use compared to LHM. Type III achalasia patients may have better outcomes with POEM compared to LHM.

Keywords

Achalasia Peroral endoscopic myotomy (POEM) Eckardt score Type III achalasia Laparoscopic Heller myotomy 

Notes

Funding

There are no funding sources to disclose in relation to this project.

Compliance with ethical standards

Disclosure

Dr. Ward, Mr. Gitelis, Dr. Patel, Dr. Vigneswaran, Mrs. Carbray, and Dr. Ujiki have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Francis DL, Katzka DA (2010) Achalasia: update on the disease and its treatment. Gastroenterology 139:369–374CrossRefPubMedGoogle Scholar
  2. 2.
    Annese V, Basciani M, Perri F, Lombardi G, Frusciante V, Si-mone P, Andriulli A, Vantrappen G (1996) Controlled trial of botulinum toxin injection versus placebo and pneumatic dilation in achalasia. Gastroenterology 111:1418–1424CrossRefPubMedGoogle Scholar
  3. 3.
    Allescher HD, Storr M, Seige M, Gonzales-Donoso R, Ott R, Born P, Frimberger E, Weigert N, Stier A, Kurjak M, Rösch TT, Classen M (2001) Treatment of achalasia: botulinum toxin injection vs. pneumatic balloon dilation. A prospective study with long-term follow-up. Endoscopy 33:1007–1017CrossRefPubMedGoogle Scholar
  4. 4.
    Leyden JE, Moss AC, MacMathuna P (2006) Endoscopic pneu-matic dilation versus botulinum toxin injection in the management of primary achalasia. Cochrane Database Syst Rev 4:CD005046Google Scholar
  5. 5.
    Kroupa R, Hep A, Dolina J, Valek V, Matyasova Z, Prokesova J, Mrazova J, Sedmik J, Novotny I (2010) Combined treatment of achalasia–botulinum toxin injection followed by pneumatic dilatation: long-term results. Dis Esophagus 23:100–105CrossRefPubMedGoogle Scholar
  6. 6.
    Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuke M, Satodate H, Odaka N, Itoh H, Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42(4):265–271CrossRefPubMedGoogle Scholar
  7. 7.
    Rajan E, Gostout CJ, Feitoza AB, Leontovich ON, Herman LJ, Burgart LJ, Chung S, Cotton PB, Hawes RH, Kalloo AN, Kantsevoy SV, Pasricha PJ (2004) Widespread EMR: a new technique for removal of large areas of mucosa. Gastrointest Endosc 60(4):623–627CrossRefPubMedGoogle Scholar
  8. 8.
    Parise P, Santi S, Solito B, Pallabazzer G, Rossi M (2011) Lap-aroscopic Heller myotomy plus Dor fundoplication in 137 achalasic patients: results on symptoms relief and successful outcome predictors. Updates Surg 63:11–15CrossRefPubMedGoogle Scholar
  9. 9.
    Kilic A, Schuchert MJ, Pennathur A, Gilbert S, Landreneau RJ, Luketich JD (2009) Long-term outcomes of laparoscopic Heller myotomy for achalasia. Surgery 146:826–831 (discussion 831–833) CrossRefPubMedGoogle Scholar
  10. 10.
    Zaninotto G, Costantini M, Rizzetto C, Zanatta L, Guirroli E, Portale G, Nicoletti L, Cavallin F, Battaglia G, Ruol A, Ancona E (2008) Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg 248:986–993CrossRefPubMedGoogle Scholar
  11. 11.
    Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271CrossRefPubMedGoogle Scholar
  12. 12.
    Hungness ES, Teitelbaum EN, Santos BF, Arafat FO, Pandolfino JE, Kahrilas PJ, Soper NJ (2013) Comparison of perioperative outcomes between peroral esophageal myotomy (POEM) and laparoscopic Heller myotomy. J Gastrointest Surg 17:228–235CrossRefPubMedGoogle Scholar
  13. 13.
    Eleftheriadis N, Inoue H, Ikeda H, Onimaru M, Yoshida A, Hosoya T, Maselli R, Kudo SE (2012) Training in peroral endoscopic myotomy (POEM) for esophageal achalasia. Ther Clin Risk Manag 8:329–342CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Swanstrom LL, Rieder E, Dunst CM (2011) A stepwise approach and early clinical experience in peroral endoscopic myotomy for the treatment of achalasia and esophageal motility disorders. J Am Coll Surg 213:751–756CrossRefPubMedGoogle Scholar
  15. 15.
    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 44:827–832CrossRefPubMedGoogle Scholar
  16. 16.
    von Rahden BH, Filser J, Reimer S, Inoue H, Germer CT (2014) Peroral endoscopic myotomy for treatment of achalasia: literature review and own initial experience. Chirurg 85(5):420–432Google Scholar
  17. 17.
    Ujiki MB, Yetasook AK, Zapf M, Linn JG, Carbray JM, Denham W (2013) Peroral endoscopic myotomy for treatment of achalasia: literature review and own initial experience. Chirurg 85(5):420–432Google Scholar
  18. 18.
    Eckardt AJ, Eckardt VF (2011) Treatment and surveillance strategies in achalasia: an update. Nat Rev Gastroenterol Hepatol 8:311–319CrossRefPubMedGoogle Scholar
  19. 19.
    Velanovich V (2007) Behavior and analysis of 36-item Short-Form Health Surveydata for surgical quality-of-life research. Arch Surg 142(5):473–477 (discussion 478) CrossRefPubMedGoogle Scholar
  20. 20.
    Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Constantini M, Cuttitta A, Elizalde JI, Fumagalli U, Gauric M, Rohof WO, Smout AJ, Tack J, Zwinderman AH, Zaninotto G, Busch OR (2011) European Achalasia Trial Investigators. Pneumatic dilation versus laparoscopic Heller’s myotomy for idio-pathic achalasia. N Engl J Med 364:1807–1816CrossRefPubMedGoogle Scholar
  21. 21.
    Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstatter M, Lin F, Ciovica R (2009) Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 249:45–57CrossRefPubMedGoogle Scholar
  22. 22.
    Sharata AM, Dunst CM, Pescarus R, Shlomovitz E, Wille AJT, Reavis KM, Swanstrom LL (2015) Peroral endscopic myotomy (POEM) for esophageal primary motility disorders: analysis of 100 consecutive patients. J Gastrointest Surg 19:161–170CrossRefPubMedGoogle Scholar
  23. 23.
    Starvropoulos 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):3322–3338CrossRefGoogle Scholar
  24. 24.
    Von Renteln D, Fuchs KH, Fockens P, Bauerfeind P, Vassiliou MC, Werner YB, Fried G, Breithaupt W, Heinrich H, Bredenoord AJ, Kersten JF, Verlaan T, Trevisonno M, Rosch T (2013) Peroroal endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology 145(2):309–311CrossRefGoogle Scholar
  25. 25.
    Pandolfino JE, Ghosh SK, Rice J, Clarke JO, Kwiatek MA, Kahrilas PJ (2008) Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls. Am J Gastroenterol 103:27–37CrossRefPubMedGoogle Scholar
  26. 26.
    Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ (2008) Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 135:1526–1533CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AJ (2012) International High Resolution Manometry Working Group: Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil 24:57–65CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Rohof WO, Salvador R, Annese V, Bruley des Varannes S, Chaussade S, Elizalde JI, Gaudric M, Smout AJ, Tack J, Busch OR, Boeckxstaens GE (2003) Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology 144:718–725 quiz e13-4 CrossRefGoogle Scholar
  29. 29.
    Rawlings A, Soper NJ, Oelschlager B, Swanstrom L, Matthews BD, Pellegrini CA, Pierce RA, Pryor A, Martin V, Frisella MM, Cassera M, Brunt LM (2012) Laparoscopic Dor versus Toupet fun- doplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc 26:18–26CrossRefPubMedGoogle Scholar
  30. 30.
    Leewenburgh I, Scholten P, Alderliesten J, Tilanus HW, Looman CWN, Steijerberg EW, Kuipers EJ (2010) Long-term esophageal cancer risk in patients with primary achalasia: a prospective study. Am J Gastroenterol 105(10):2144–2149CrossRefGoogle Scholar
  31. 31.
    Youssef Y, Richards WO, Sharp K, Holzman M, Sekhar N, Kaiser J, Torquati A (2007) Relief of dysphagia after laparoscopic Heller myotomy improves long-term quality of life. J Gastrointest Surg 11:309–313CrossRefPubMedGoogle Scholar
  32. 32.
    Katilius M, Velanovich V (2001) Heller myotomy for achalasia: quality of life comparison of laparoscopic and open approaches. J Soc Laparoendosc Surg 5:227–231Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Marc A. Ward
    • 1
    Email author
  • Matt Gitelis
    • 2
  • Lava Patel
    • 2
  • Yalini Vigneswaran
    • 1
  • Joann Carbray
    • 2
  • Michael B. Ujiki
    • 1
    • 2
  1. 1.Department of SurgeryUniversity of ChicagoChicagoUSA
  2. 2.Department of SurgeryNorthShore University HealthSystemEvanstonUSA

Personalised recommendations