Advertisement

Surgical Endoscopy

, Volume 31, Issue 6, pp 2596–2601 | Cite as

Long-term outcome of peroral endoscopic myotomy for esophageal achalasia in patients with previous Heller myotomy

  • Helle Ø. Kristensen
  • Jakob KirkegårdEmail author
  • Daniel Willy Kjær
  • Frank Viborg Mortensen
  • Rastislav Kunda
  • Niels Christian Bjerregaard
Article

Abstract

Background

Peroral endoscopic myotomy (POEM) is an emerging procedure in the treatment of esophageal achalasia, a primary motility disorder. However, the long-term outcome of POEM in patients, who have previously undergone a Heller myotomy, is unknown.

Methods

Using a local database, we identified patients with esophageal achalasia, who underwent POEM. We compared patients with a previous Heller myotomy to those, who had received none or only non-surgical therapy prior to the POEM procedure. We conducted follow-up examinations at 3, 12, and 24 months following the procedure.

Results

We included 66 consecutive patients undergoing POEM for achalasia, of which 14 (21.2 %) had undergone a prior Heller myotomy. In both groups, the preoperative Eckardt score was 7. Postoperatively, the non-Heller group experienced a more pronounced symptom relief at both 3-, 12-, and 24-month follow-up compared with the Heller group, and there was a tendency for the effect of POEM to reduce over time. We suggest that there is a correlation between preoperative measurements of gastroesophageal sphincter pressures and the chance of a successful POEM.

Conclusions

POEM has a place in the treatment of esophageal achalasia in patients with a prior Heller myotomy and persistent symptoms as it is a safe procedure with acceptable long-term results.

Keywords

Achalasia Peroral endoscopic myotomy POEM Heller myotomy Esophagus Motility disorder 

Notes

Acknowledgments

The authors acknowledge Karin Bak Aksglæde MD, DMSc for performing the high-resolution manometry and 24-hour pH study.

Funding

None.

Compliance with ethical standards

Disclosures

Rastislav Kunda is speaker and consultant for Boston Scientific, Olympus Japan, Pentax, Xlumena, Omega Medical Imaging, and BCM. MD.’s Helle Ø. Kristensen, Jakob Kirkegård, Daniel Willy Kjær, Frank Viborg Mortensen, Niels Christian Bjerregaard have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Goldblum JR, Rice TW, Richter JE (1996) Histopathologic features in esophagomyotomy specimens from patients with achalasia. Gastroenterology 111(3):648–654CrossRefPubMedGoogle Scholar
  2. 2.
    Goldblum JR, Whyte RI, Orringer MB, Appelman HD (1994) Achalasia. A morphologic study of 42 resected specimens. Am J Surg Pathol 18(4):327–337CrossRefPubMedGoogle Scholar
  3. 3.
    Vaezi MF, Pandolfino JE, Vela MF (2013) ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol 108(8):1238–1249 quiz 1250 CrossRefPubMedGoogle Scholar
  4. 4.
    Boeckxstaens GE, Zaninotto G, Richter JE (2014) Achalasia. Lancet 383(9911):83–93CrossRefPubMedGoogle Scholar
  5. 5.
    Howard PJ, Maher L, Pryde A, Cameron EW, Heading RC (1992) Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh. Gut 33(8):1011–1015CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Pasricha PJ, Hawari R, Ahmed I, Chen J, Cotton PB, Hawes RH, Kalloo AN, Kantsevoy SV, Gostout CJ (2007) Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia. Endoscopy 39(9):761–764CrossRefPubMedGoogle Scholar
  7. 7.
    Talukdar R, Inoue H, Nageshwar Reddy D (2015) Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis. Surg Endosc 29(11):3030–3046CrossRefPubMedGoogle Scholar
  8. 8.
    Inoue H, Sato H, Ikeda H, Onimaru M, Sato C, Minami H, Yokomichi H, Kobayashi Y, Grimes KL, Kudo SE (2015) Per-oral endoscopic myotomy: a series of 500 patients. J Am Coll Surg 221(2):256–264CrossRefPubMedGoogle Scholar
  9. 9.
    Vigneswaran Y, Yetasook AK, Zhao JC, Denham W, Linn JG, Ujiki MB (2014) Peroral endoscopic myotomy (POEM): feasible as reoperation following Heller myotomy. J Gastrointest Surg 18(6):1071–1076CrossRefPubMedGoogle Scholar
  10. 10.
    Orenstein SB, Raigani S, Wu YV, Pauli EM, Phillips MS, Ponsky JL, Marks JM (2015) Peroral endoscopic myotomy (POEM) leads to similar results in patients with and without prior endoscopic or surgical therapy. Surg Endosc 29(5):1064–1070CrossRefPubMedGoogle Scholar
  11. 11.
    Zhou PH, Li QL, Yao LQ, Xu MD, Chen WF, Cai MY, Hu JW, Li L, Zhang YQ, Zhong YS, Ma LL, Qin WZ, Cui Z (2013) Peroral endoscopic remyotomy for failed Heller myotomy: a prospective single-center study. Endoscopy 45(3):161–166CrossRefPubMedGoogle Scholar
  12. 12.
    Onimaru M, Inoue H, Ikeda H, Yoshida A, Santi EG, Sato H, Ito H, Maselli R, Kudo SE (2013) Peroral endoscopic myotomy is a viable option for failed surgical esophagocardiomyotomy instead of redo surgical Heller myotomy: a single center prospective study. J Am Coll Surg 217(4):598–605CrossRefPubMedGoogle Scholar
  13. 13.
    Fumagalli U, Rosati R, De Pascale S, Porta M, Carlani E, Pestalozza A, Repici A (2016) Repeated surgical or endoscopic myotomy for recurrent dysphagia in patients after previous myotomy for achalasia. J Gastrointest Surg 20(3):494–499CrossRefPubMedGoogle Scholar
  14. 14.
    Eckardt VF, Aignherr C, Bernhard G (1992) Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 103(6):1732–1738CrossRefPubMedGoogle Scholar
  15. 15.
    Arain MA, Peters JH, Tamhankar AP, Portale G, Almogy G, DeMeester SR, Crookes PF, Hagen JA, Bremner CG, DeMeester TR (2004) Preoperative lower esophageal sphincter pressure affects outcome of laparoscopic esophageal myotomy for achalasia. J Gastrointest Surg 8(3):328–334CrossRefPubMedGoogle Scholar
  16. 16.
    Torquati A, Richards WO, Holzman MD, Sharp KW (2006) Laparoscopic myotomy for achalasia: predictors of successful outcome after 200 cases. Ann Surg 243(5):587–591 discussion 591-583 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    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(6):986–993CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Helle Ø. Kristensen
    • 1
  • Jakob Kirkegård
    • 1
    Email author
  • Daniel Willy Kjær
    • 1
  • Frank Viborg Mortensen
    • 1
  • Rastislav Kunda
    • 1
  • Niels Christian Bjerregaard
    • 1
  1. 1.Department of Surgery, Section for Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, L-research, Building 1CAarhus University HospitalAarhus CDenmark

Personalised recommendations