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Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for treatment of achalasia

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Abstract

Background

Peroral esophageal myotomy (POEM) is a new endoscopic operation for the treatment of achalasia. Here, we report 1-year physiologic and symptomatic outcomes following the procedure.

Methods

POEM patients from a single-institution series who were more than 1 year removed from surgery were studied. Eckardt and GerdQ scores were obtained to assess symptoms. High-resolution manometry (HRM), timed barium esophagram (TBE), and upper endoscopy were preformed preoperatively and at 1-year follow-up. 24-h pH monitoring was also performed at 1 year follow-up.

Results

The study population was comprised of 41 patients who were more than 1 year post-POEM. One (2 %) major complication, a contained leak at the EGJ requiring re-operation, and 7 (17 %) minor complications occurred. Mean length of stay was 1.4 days. At mean 15-month follow-up, Eckardt scores improved from pre-POEM 7 ± 2 to post-POEM 1 ± 2, (scale 0–12, p < .001), and 92 % of patients achieved treatment success (Eckardt score <4). Two of the three treatment failures in the series occurred in the initial three patients. 15 % of patients had post-POEM symptoms suggestive of gastroesophageal reflux (GerdQ >7). On follow-up HRM, esophagogastric junction integrated relaxation pressure was decreased significantly (pre-POEM 28 ± 12 mmHg vs. post-POEM 11 ± 4 mmHg, p < .001), and 47 % of patients studied had partial recovery of peristalsis. On follow-up TBE, barium column heights were decreased compared with preoperatively. Postoperative upper endoscopy revealed esophagitis in 59 % of patients (11 LA Grade A, 2 LA Grade D). However, of the 13 24-h pH monitoring studies performed, only four (31 %) demonstrated pathologic esophageal acid exposure.

Conclusions

In this series, POEM resulted in greater than 90 % symptomatic treatment success at mean 15-month follow-up. Rates of iatrogenic gastroesophageal reflux, as measured both by symptoms and 24-h pH monitoring, appeared to be on par with recent studies of patients undergoing laparoscopic Heller myotomy and pneumatic dilation.

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Acknowledgments

The authors would like to acknowledge Rowena Martinez, RN, Colleen Krantz, RN, Jordan Swiskow, RN, and Kristina Dykstra, RN, for their help coordinating the clinical aspects of this study.

Disclosures

Olympus America, Inc. granted instruments that were used during some of the POEM procedures, but was not otherwise involved in this study. Nathaniel Soper is on the scientific advisory boards of TransEnterix and Miret Surgical, which are unrelated to this study. Ezra Teitelbaum, Byron Santos, Fahd Arafat, John Pandolfino, Peter Kahrilas, Ikuo Hirano, and Eric Hungness have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Chicago, IL, 60611, USA

    Ezra N. Teitelbaum, Nathaniel J. Soper, Fahd O. Arafat & Eric S. Hungness

  2. Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Byron F. Santos

  3. Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    John E. Pandolfino, Peter J. Kahrilas & Ikuo Hirano

Authors
  1. Ezra N. Teitelbaum
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  2. Nathaniel J. Soper
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  3. Byron F. Santos
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  4. Fahd O. Arafat
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  5. John E. Pandolfino
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  6. Peter J. Kahrilas
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  7. Ikuo Hirano
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  8. Eric S. Hungness
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Correspondence to Ezra N. Teitelbaum.

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Teitelbaum, E.N., Soper, N.J., Santos, B.F. et al. Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for treatment of achalasia. Surg Endosc 28, 3359–3365 (2014). https://doi.org/10.1007/s00464-014-3628-1

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  • DOI: https://doi.org/10.1007/s00464-014-3628-1

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