Abstract
Purpose
The purpose of this study was to demonstrate the feasibility of performing peroral endoscopic myotomy (POEM) in the management of recurrent achalasia after failed myotomy.
Methods
Eight patients presented to our institution between October 2010 and June 2013 with recurrent/persistent symptoms after prior laparoscopic Heller myotomy. Three patients underwent redo laparoscopic Heller myotomy, and five patients consented to redo myotomy with POEM.
Results
Demographics were similar between the groups with exception of age (POEM 69.5 vs. laparoscopic Heller myotomy (LHM) 34.5, p = 0.003). Preoperative Eckardt scores, motility, and prior interventions were not significantly different. Three patients who underwent POEM and two who underwent laparoscopic Heller myotomy had prior fundoplication. There was one perforation identified after laparoscopic Heller myotomy and one patient with persistent subcutaneous emphysema after POEM. Both POEM and laparoscopic Heller myotomy demonstrated significant improvement in symptoms and Eckardt scores at average follow-up of approximately 5 months (p < 0.05).
Conclusion
POEM is a feasible option for patients after failed myotomy even in the presence of prior fundoplication. The procedure can be performed safely using a similar technique as for primary myotomy with the exception of creating the myotomy laterally along the right side of the esophagus and lesser curvature avoiding the previous anterior myotomy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Inoue, H.; Minami, H.; Kobayashi, Y.; Sato, Y.; Kaga, M.; Suzuki, M.; Satodate, H.; Odaka, N.; Itoh, H.; Kudo, S., Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010, 42 (4), 265-71.
Swanstrom, L. L.; Kurian, A.; Dunst, C. M.; Sharata, A.; Bhayani, N.; Rieder, E., Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg 2012, 256 (4), 659-67.
Zaninotto, G.; Costantini, M.; Molena, D.; Buin, F.; Carta, A.; Nicoletti, L.; Ancona, E., Treatment of esophageal achalasia with laparoscopic Heller myotomy and Dor partial anterior fundoplication: prospective evaluation of 100 consecutive patients. J Gastrointest Surg 2000, 4 (3), 282-9
Hunter, J. G.; Trus, T. L.; Branum, G. D.; Waring, J. P., Laparoscopic Heller myotomy and fundoplication for achalasia. Ann Surg 1997, 225 (6), 655-64; discussion 664-5.
Zaninotto, G.; Costantini, M.; Portale, G.; Battaglia, G.; Molena, D.; Carta, A.; Costantino, M.; Nicoletti, L.; Ancona, E., Etiology, diagnosis, and treatment of failures after laparoscopic Heller myotomy for achalasia. Ann Surg 2002, 235 (2), 186-92.
Donahue, P. E.; Teresi, M.; Patel, S.; Schlesinger, P. K., Laparoscopic myotomy in achalasia: intraoperative evidence for myotomy of the gastric cardia. Dis Esophagus 1999, 12 (1), 30-6.
Eckardt, A. J.; Eckardt, V. F., Current clinical approach to achalasia. World J Gastroenterol 2009, 15 (32), 3969-75.
Ujiki, M. B.; Yetasook, A. K.; Zapf, M.; Linn, J. G.; Carbray, J. M.; Denham, W., Peroral endoscopic myotomy: A short-term comparison with the standard laparoscopic approach. Surgery 2013, 154 (4), 893-7; discussion 897-900.
Vaezi, M. F.; Richter, J. E., Diagnosis and management of achalasia. American College of Gastroenterology Practice Parameter Committee. Am J Gastroenterol 1999, 94 (12), 3406-12.
Campos, G. M.; Vittinghoff, E.; Rabl, C.; Takata, M.; Gadenstätter, M.; Lin, F.; Ciovica, R., Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 2009, 249 (1), 45-57.
Guardino, J. M.; Vela, M. F.; Connor, J. T.; Richter, J. E., Pneumatic dilation for the treatment of achalasia in untreated patients and patients with failed Heller myotomy. J Clin Gastroenterol 2004, 38 (10), 855-60.
Patti, M. G.; Molena, D.; Fisichella, P. M.; Whang, K.; Yamada, H.; Perretta, S.; Way, L. W., Laparoscopic Heller myotomy and Dor fundoplication for achalasia: analysis of successes and failures. Arch Surg 2001, 136 (8), 870-7.
Gorecki, P. J.; Hinder, R. A.; Libbey, J. S.; Bammer, T.; Floch, N., Redo laparoscopic surgery for achalasia. Surg Endosc 2002, 16 (5), 772-6.
Duffy, P. E.; Awad, Z. T.; Filipi, C. J., The laparoscopic reoperation of failed Heller myotomy. Surg Endosc 2003, 17 (7), 1046-9.
Rossetti, G.; del Genio, G.; Maffettone, V.; Fei, L.; Brusciano, L.; Limongelli, P.; Pizza, F.; Tolone, S.; Di Martino, M.; del Genio, F.; del Genio, A., Laparoscopic reoperation with total fundoplication for failed Heller myotomy: is it a possible option? Personal experience and review of literature. Int Surg 2009, 94 (4), 330-4.
James, D. R.; Purkayastha, S.; Aziz, O.; Amygdalos, I.; Darzi, A. W.; Hanna, G. B.; Zacharakis, E., The feasibility, safety and outcomes of laparoscopic re-operation for achalasia. Minim Invasive Ther Allied Technol 2012, 21 (3), 161-7.
Author information
Authors and Affiliations
Corresponding author
Additional information
This study was presented as a plenary presentation at the Society for Surgery of the Alimentary Tract May 2013 meeting, Orlando, Florida.
Rights and permissions
About this article
Cite this article
Vigneswaran, Y., Yetasook, A.K., Zhao, JC. et al. Peroral Endoscopic Myotomy (POEM): Feasible as Reoperation Following Heller Myotomy. J Gastrointest Surg 18, 1071–1076 (2014). https://doi.org/10.1007/s11605-014-2496-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-014-2496-2