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Long-Term Efficacy of Peroral Endoscopic Myotomy for Patients with Achalasia: Outcomes with a Median Follow-Up of 36 Months

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Abstract

Objective

This study aimed to evaluate the long-term efficacy of peroral endoscopic myotomy (POEM) for patients with achalasia.

Methods

Prospective data collected from 115 patients (median age 45 years; interquartile range 34–57) with achalasia who underwent POEM at the First Affiliated Hospital of ZheJiang Chinese Medical University with a median follow-up of 36 months were retrospectively analyzed. The Eckardt score and lower esophageal sphincter pressure changes were analyzed, and the gastroesophageal reflux was observed.

Results

During the final follow-up, the mean Eckardt score reduced from 7.5 ± 1.9 preoperatively to 2.3 ± 1.4 after 1 month of surgery (P < 0.001). Treatment success was observed in 91.3% [confidence interval (CI) 86.2–96.4], 90.3% (CI 84.8–95.8), 89.0% (CI 83.1–94.9), 83.7% (CI 75.7–91.7), and 80.1% (CI 69.7–90.5) of patients after 12, 24, 36, 48, and 60 months, respectively. A total of 16 (13.9%) failures occurred. Four patients were nonresponders (failure within 3 months), eight had an early recurrence (between 3 months and 3 years), and four had a late recurrence (after 3 years). Further, 21 (20.6%) patients had symptoms of reflux during the two-year follow-up. Only one patient with symptomatic reflux was newly added during the subsequent three-year follow-up. Moreover, 71 (61.7%) patients underwent gastroscopy after POEM, and 13 (18.3%) patients were diagnosed with reflux esophagitis.

Conclusion

POEM is safe and effective in treating achalasia and has a favorable long-term efficacy.

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Acknowledgments

The authors thank Kejia Zhao and Xianjing Zhao for assisting in the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, 310006, China

    Chenghai He, Meng Li, Bin Lu, Xiao Ying, Chen Gao, Shuangshuang Wang, Chengao Ma & Chaoqiong Jin

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  1. Chenghai He
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  2. Meng Li
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Correspondence to Bin Lu.

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He, C., Li, M., Lu, B. et al. Long-Term Efficacy of Peroral Endoscopic Myotomy for Patients with Achalasia: Outcomes with a Median Follow-Up of 36 Months. Dig Dis Sci 64, 803–810 (2019). https://doi.org/10.1007/s10620-018-5373-0

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  • DOI: https://doi.org/10.1007/s10620-018-5373-0

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