Long-term outcome of peroral endoscopic myotomy for esophageal achalasia in patients with previous Heller myotomy
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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.
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.
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.
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.
KeywordsAchalasia Peroral endoscopic myotomy POEM Heller myotomy Esophagus Motility disorder
The authors acknowledge Karin Bak Aksglæde MD, DMSc for performing the high-resolution manometry and 24-hour pH study.
Compliance with ethical standards
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.
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