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Peroral endoscopic myotomy for the treatment of achalasia after failed pneumatic dilation

Surgical Endoscopy volume 35, pages 6960–6968 (2021)Cite this article

Abstract

Background and aims

POEM is a rescue endoscopic therapy for patients who had previously failed surgical or endoscopic treatment. However, data regarding its effectiveness after failed pneumatic dilation (PD) and its long-term effects are limited. We aimed to retrospectively investigate the long-term outcomes in patients who had undergone POEM after failed PD.

Methods

Data from 66 achalasia patients with a 2-year follow-up period were analyzed. Intraprocedural events were compared between the first POEM group (patients without prior-endoscopic intervention) and prior PD group (patients who had pre-POEM PD). Symptom evaluation, HRM and 24 h-pH DeMeester scores between the two groups were performed at 2 years after the POEM procedure. Muscularis externa samples were obtained from the lower esophagus using POEM to assess the muscle fibrosis with Azan-Mallory staining.

Results

POEM was successfully performed for all achalasia patients. During the 2-year follow-up period, the success rate of POEM was 96.15% (25/26) for patients with prior PD and 95% (38/40) with primary POEM. For patients with type II achalasia and who underwent prior PD, the post-procedure DeMeester score was higher compared to patients who underwent POEM only (P < 0.05). A larger number of patients who underwent primary POEM (27.50%, 11/40) complained of mild heartburn compared to patients who underwent POEM after PD (7.69%, 2/26) (P < 0.05). With regards to fibrosis, the majority of patients who underwent POEM only were classified as F-1 (45.00%, 18/40), while the majority of patients who underwent prior PD were classified as F-2 (42.3%, 11/26). The degree of fibrosis was significantly different between the two groups (P < 0.05). Both surgical time and prior PD were correlated with the degree of fibrosis (P < 0.05).

Conclusions

Despite the technical challenges, pre-POEM endoscopic treatment does not impact the safety and efficacy of POEM in achalasia patients. Longer follow-up studies using larger cohorts are needed to determine long-term outcomes and complications of POEM.

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Acknowledgements

Ethical NO. IRB2014-YX-064. This work was supported by the National Natural Science Foundation of China under Grant [No. 81370492]. This work was supported by the Tianjin Zhao Yicheng Medical Science Foundation [No. ZYYFY 2018021].

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  1. Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, 300070, China

    Hong Jin, Bin Wang, Zhong-qing Zheng, Li-li Zhang, Qiu-yu Chen, Chun Shan Zhao, Bang-mao Wang & Wei Zhao

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  1. Hong Jin
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Correspondence to Wei Zhao.

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Hong Jin, Bin Wang, Zhong-qing Zheng, Li-li Zhang, Qiu-yu Chen, Chun Shan Zhao, Bang-mao Wang and Wei Zhao have no conflict of interest of financial ties to disclose.

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Jin, H., Wang, B., Zheng, Zq. et al. Peroral endoscopic myotomy for the treatment of achalasia after failed pneumatic dilation. Surg Endosc 35, 6960–6968 (2021). https://doi.org/10.1007/s00464-020-08207-x

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Keywords

  • Achalasia
  • Peroral endoscopic myotomy (POEM)
  • Pneumatic dilation (PD)
  • Fibrosis
  • Effect