Skip to main content
SpringerLink
Log in

Clinical outcomes five years after POEM for treatment of primary esophageal motility disorders

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Peroral endoscopic myotomy (POEM) is a novel operation for the treatment of achalasia and other esophageal motility disorders. While POEM has shown excellent short-term safety and efficacy, the long-term symptomatic outcomes after the procedure are unknown.

Methods

Patients from a single center that underwent POEM for treatment of esophageal motility orders and were greater than 5 years removed from their operation were studied. Patients were contacted to assess current symptoms and encouraged to undergo repeat endoscopy for objective follow-up.

Results

Thirty-six patients underwent POEM from October, 2010 to February, 2012 and current symptom scores were obtained from 29 patients at median 65-month follow-up. In the 23 patients with achalasia, Eckardt scores were significantly improved from preoperative baseline (mean current 1.7 vs. preoperative 6.4, p < 0.001). Nineteen patients (83%) with achalasia had a symptomatic success (Eckardt ≤3) and none required retreatment for symptoms. Eckardt scores were dramatically improved at 6 months and maintained at 2 years; however, there was a small but significant worsening of symptoms between 2 and 5-years. Of the five patients with EGJ outflow obstruction, all had current Eckardt scores ≤3 but two needed reintervention for persistent or recurrent symptoms, one with a laparoscopic Heller myotomy and another with an endoscopic cricomyotomy and proximal esophageal myotomy extension. At 6-month follow-up, repeat manometry showed decreased EGJ relaxation pressures and esophagram demonstrated improved emptying. 24-h pH monitoring showed abnormal distal esophageal acid exposure in 38% of patients. Fifteen patients underwent endoscopy at 5-years, revealing erosive esophagitis in two (13%), new hiatal hernia in two, and new non-dysplastic Barrett’s esophagus in one. The patient with Barrett’s underwent a subsequent laparoscopic hiatal hernia repair and Toupet fundoplication.

Conclusions

POEM resulted in a successful palliation of symptoms in the majority of patients after 5 years, though these results emphasize the importance of long-term follow-up in all patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Boeckxstaens GE, Zaninotto G, Richter JE (2014) Achalasia. Lancet 383:83–93

    Article  PubMed  Google Scholar 

  2. Yaghoobi M, Mayrand S, Martel M, Roshan-Afshar I, Bijarchi R, Barkun A (2013) Laparoscopic Heller’s myotomy versus pneumatic dilation in the treatment of idiopathic achalasia: a meta-analysis of randomized, controlled trials. Gastrointest Endosc 78:468–475

    Article  PubMed  Google Scholar 

  3. Moonen A, Annese V, Belmans A, Bredenoord AJ, Bruley des Varannes S, Costantini M, Dousset B, Elizalde JI, Fumagalli U, Gaudric M, Merla A, Smout AJ, Tack J, Zaninotto G, Busch OR, Boeckxstaens GE (2016) Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut 65:732–739

    Article  PubMed  Google Scholar 

  4. Schoenberg MB, Marx S, Kersten JF, Rosch T, Belle S, Kahler G, Vassiliou MC, Luth S, von Renteln D (2013) Laparoscopic Heller myotomy versus endoscopic balloon dilatation for the treatment of achalasia: a network meta-analysis. Ann Surg 258:943–952

    Article  PubMed  Google Scholar 

  5. Sawas T, Ravi K, Geno DM, Enders F, Pierce K, Wigle D, Katzka DA (2017) The course of achalasia one to four decades after initial treatment. Aliment Pharmacol Ther 45:553–560

    Article  CAS  PubMed  Google Scholar 

  6. Vela MF, Richter JE, Khandwala F, Blackstone EH, Wachsberger D, Baker ME, Rice TW (2006) The long-term efficacy of pneumatic dilatation and Heller myotomy for the treatment of achalasia. Clin Gastroenterol Hepatol 4:580–587

    Article  PubMed  Google Scholar 

  7. 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 42:265–271

    Article  CAS  PubMed  Google Scholar 

  8. Bhayani NH, Kurian AA, Dunst CM, Sharata AM, Rieder E, Swanstrom LL (2014) A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann Surg 259:1098–1103

    Article  PubMed  Google Scholar 

  9. von Renteln D, Inoue H, Minami H, Werner YB, Pace A, Kersten JF, Much CC, Schachschal G, Mann O, Keller J, Fuchs KH, Rosch T (2012) Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol 107:411–417

    Article  Google Scholar 

  10. Hungness ES, Sternbach JM, Teitelbaum EN, Kahrilas PJ, Pandolfino JE, Soper NJ (2016) Per-oral endoscopic myotomy (POEM) after the learning curve: durable long-term results with a low complication rate. Ann Surg 264:508–517

    Article  PubMed  Google Scholar 

  11. Werner YB, Costamagna G, Swanstrom LL, von Renteln D, Familiari P, Sharata AM, Noder T, Schachschal G, Kersten JF, Rosch T (2016) Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut 65:899–906

    Article  CAS  PubMed  Google Scholar 

  12. 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 221:256–264

    Article  PubMed  Google Scholar 

  13. Eckardt VF (2001) Clinical presentations and complications of achalasia. Gastrointest Endosc Clin N Am 11:281–292

    CAS  PubMed  Google Scholar 

  14. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE, International High Resolution Manometry Working G (2015) The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 27:160–174

    Article  CAS  PubMed  Google Scholar 

  15. 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 213:751–756

    Article  PubMed  Google Scholar 

  16. Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttitta A, Elizalde JI, Fumagalli U, Gaudric M, Rohof WO, Smout AJ, Tack J, Zwinderman J, Zaninotto G, Busch OR, European Achalasia Trial I (2011) Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med 364:1807–1816

    Article  CAS  PubMed  Google Scholar 

  17. Jones R, Junghard O, Dent J, Vakil N, Halling K, Wernersson B, Lind T (2009) Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther 30:1030–1038

    Article  CAS  PubMed  Google Scholar 

  18. 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 248:986–993

    Article  PubMed  Google Scholar 

  19. Rawlings A, Soper NJ, Oelschlager B, Swanstrom L, Matthews BD, Pellegrini C, Pierce RA, Pryor A, Martin V, Frisella MM, Cassera M, Brunt LM (2012) Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc 26:18–26

    Article  PubMed  Google Scholar 

  20. Familiari P, Gigante G, Marchese M, Boskoski I, Tringali A, Perri V, Costamagna G (2016) Peroral endoscopic myotomy for esophageal achalasia: outcomes of the first 100 patients with short-term follow-up. Ann Surg 263:82–87

    Article  PubMed  Google Scholar 

  21. Gholoum S, Feldman LS, Andrew CG, Bergman S, Demyttenaere S, Mayrand S, Stanbridge DD, Fried GM (2006) Relationship between subjective and objective outcome measures after Heller myotomy and Dor fundoplication for achalasia. Surg Endosc 20:214–219

    Article  CAS  PubMed  Google Scholar 

  22. Okeke FC, Raja S, Lynch KL, Dhalla S, Nandwani M, Stein EM, Chander Roland B, Khashab MA, Saxena P, Kumbhari V, Ahuja NK, Clarke JO (2017) What is the clinical significance of esophagogastric junction outflow obstruction? evaluation of 60 patients at a tertiary referral center. Neurogastroenterol Motil. doi:10.1111/nmo.13061

    PubMed  Google Scholar 

  23. Perez-Fernandez MT, Santander C, Marinero A, Burgos-Santamaria D, Chavarria-Herbozo C (2016) Characterization and follow-up of esophagogastric junction outflow obstruction detected by high resolution manometry. Neurogastroenterol Motil 28:116–126

    Article  PubMed  Google Scholar 

  24. Teitelbaum EN, Soper NJ, Arafat FO, Santos BF, Kahrilas PJ, Pandolfino JE, Hungness ES (2014) Analysis of a learning curve and predictors of intraoperative difficulty for peroral esophageal myotomy (POEM). J Gastrointest Surg 18:92–98 discussion 8–9

    Article  PubMed  Google Scholar 

  25. Kurian AA, Dunst CM, Sharata A, Bhayani NH, Reavis KM, Swanstrom LL (2013) Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc 77:719–725

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge Angie Gill, RN, and Lisa Leeth for their help coordinating the clinical aspects of this study.

Author information

Authors and Affiliations

  1. Providence Cancer Center, Providence Portland Medical Center, Portland, OR, USA

    Ezra N. Teitelbaum, Christy M. Dunst, Kevin M. Reavis, Marc A. Ward, Steven R. DeMeester & Lee L. Swanström

  2. Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, OR, USA

    Christy M. Dunst, Kevin M. Reavis, Ahmed M. Sharata, Steven R. DeMeester & Lee L. Swanström

  3. Institute of Image Guided Surgery, IHU-Strasbourg, 6N60, 4508 NE Glisan, Portland, OR, 97213, USA

    Lee L. Swanström

Authors
  1. Ezra N. Teitelbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christy M. Dunst
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kevin M. Reavis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ahmed M. Sharata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marc A. Ward
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Steven R. DeMeester
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lee L. Swanström
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lee L. Swanström.

Ethics declarations

Disclosures

Dr. Reavis is a consultant for Boston Scientific, Endogastric Solutions, and Stryker, and receives teaching or advisory honoraria from Ethicon, Mederi, Gore, and Apollo. Dr. DeMeester is a consultant for Bard. Dr. Swanstrom is on the scientific advisory boards of Olympus and Boston Scientific. These disclosures are not related to the current study. Drs. Teitelbaum, Dunst, Sharata, and Ward have no disclosures or conflicts of interest to report.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Teitelbaum, E.N., Dunst, C.M., Reavis, K.M. et al. Clinical outcomes five years after POEM for treatment of primary esophageal motility disorders. Surg Endosc 32, 421–427 (2018). https://doi.org/10.1007/s00464-017-5699-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-017-5699-2

Keywords

Search

Navigation