Skip to main content

Advertisement

SpringerLink
Log in

Per-oral endoscopic myotomy and gastroesophageal reflux: Where do we stand after a decade of “POETRY”?

  • Review Article
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Per-oral endoscopic myotomy (POEM) was introduced nearly a decade ago. Since then, the literature on its safety and efficacy has been ever increasing. Initial studies focused solely on the feasibility and efficacy of this procedure in patients with idiopathic achalasia. Subsequent studies analyzed the incidence of gastroesophageal reflux disease (GERD) in addition to the efficacy of POEM. These studies depict a high incidence of GERD after POEM. However, vast majority of these studies lacked a comprehensive evaluation of GERD after POEM. Consequently, it is difficult to provide a true estimate of the incidence of GERD in these patients. Majority of the patients with post-POEM GERD are asymptomatic and those with symptoms usually respond well to proton pump inhibitors. However, the long-term consequences of asymptomatic GERD with increased esophageal acid exposure are not well known. These patients should probably undergo regular surveillance due to theoretical risks of complications like Barrett’s esophagus and esophageal adenocarcinoma. It should be acknowledged that there is no well-controlled study to support the strategy of surveillance in this group of patients. Given the high incidence of GERD after POEM, it is time to devise minimally invasive novel strategies to prevent and manage post-POEM GERD. The current literature suggests that the technique of POEM and other factors like type of achalasia do not influence the occurrence of GERD after POEM. Therefore, the endoscopists will need to think out of the box to prevent post-POEM GERD.

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. Inoue H, Sato H, Ikeda H, et al. Per-oral endoscopic myotomy: a series of 500 patients. J Am Coll Surg. 2015;221:256–64.

  2. Nabi Z, Ramchandani M, Chavan R, et al. Per-oral endoscopic myotomy for achalasia cardia: outcomes in over 400 consecutive patients. Endosc Int Open. 2017;5:E331–E9.

  3. Nabi Z, Reddy DN, Ramchandani M. Adverse events during and after per-oral endoscopic myotomy: prevention, diagnosis, and management. Gastrointest Endosc. 2017;87:4–17.

  4. Ujiki MB, Yetasook AK, Zapf M, Linn JG, Carbray JM, Denham W. Peroral endoscopic myotomy: a short-term comparison with the standard laparoscopic approach. Surgery. 2013;154:893–7; discussion 7-900.

  5. Kumbhari V, Tieu AH, Onimaru M, et al. Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open. 2015;3:E195–201.

  6. Benias PC, Korrapati P, Raphael KL, et al. Safety and feasibility of performing peroral endoscopic myotomy as an outpatient procedure with same-day discharge. Gastrointest Endosc. 2019. https://doi.org/10.1016/j.gie.2019.04.247.

  7. Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71.

  8. Swanstrom LL, Rieder E, Dunst CM. A stepwise approach and early clinical experience in peroral endoscopic myotomy for the treatment of achalasia and esophageal motility disorders. J Am Coll Surg. 2011;213:751–6.

  9. Costamagna G, Marchese M, Familiari P, Tringali A, Inoue H, Perri V. Peroral endoscopic myotomy (POEM) for oesophageal achalasia: preliminary results in humans. Dig Liver Dis. 2012;44:827–32.

  10. Swanstrom LL, Kurian A, Dunst CM, Sharata A, Bhayani N, Rieder E. Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg. 2012;256:659–67.

  11. Shiwaku H, Inoue H, Sasaki T, et al. A prospective analysis of GERD after POEM on anterior myotomy. Surg Endosc. 2016;30:2496–504.

  12. Hungness ES, Sternbach JM, Teitelbaum EN, Kahrilas PJ, Pandolfino JE, Soper NJ. Per-oral endoscopic myotomy (POEM) after the learning curve: durable long-term results with a low complication rate. Ann Surg. 2016;264:508–17.

  13. Kumbhari V, Familiari P, Bjerregaard NC, et al. Gastroesophageal reflux after peroral endoscopic myotomy: a multicenter case-control study. Endoscopy. 2017;49:634–42.

  14. Nabi Z, Ramchandani M, Chavan R, et al. Peroral endoscopic myotomy in treatment-naive achalasia patients versus prior treatment failure cases. Endoscopy. 2017;50:358–70.

  15. Zaninotto G, Bennett C, Boeckxstaens G, et al. The ISDE achalasia guidelines. Dis Esophagus. 2018;31. https://doi.org/10.1093/dote/doy071.

  16. Lee Y, Brar K, Doumouras AG, Hong D. Peroral endoscopic myotomy (POEM) for the treatment of pediatric achalasia: a systematic review and meta-analysis. Surg Endosc. 2019;33:1710–20.

  17. Chen WF, Li QL, Zhou PH, et al. Long-term outcomes of peroral endoscopic myotomy for achalasia in pediatric patients: a prospective, single-center study. Gastrointest Endosc. 2015;81:91–100.

  18. Nabi Z, Ramchandani M, Chavan R, et al. Outcome of peroral endoscopic myotomy in children with achalasia. Surg Endosc. 2019. https://doi.org/10.1007/s00464-018-06654-1.

  19. Boeckxstaens GE, Annese V, des Varannes SB, et al. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 2011;364:1807–16.

  20. Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009;249:45–57.

  21. Richards WO, Torquati A, Holzman MD, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004;240:405–12 discussion 12-5.

  22. Familiari P, Greco S, Gigante G, et al. Gastroesophageal reflux disease after peroral endoscopic myotomy: analysis of clinical, procedural and functional factors, associated with gastroesophageal reflux disease and esophagitis. Dig Endosc. 2016;28:33–41.

  23. Bhayani NH, Kurian AA, Dunst CM, Sharata AM, Rieder E, Swanstrom LL. A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann Surg. 2014;259:1098–103.

  24. Sanaka MR, Thota PN, Parikh MP, et al. Peroral endoscopic myotomy leads to higher rates of abnormal esophageal acid exposure than laparoscopic Heller myotomy in achalasia. Surg Endosc. 2018;33:2284–92.

  25. Repici A, Fuccio L, Maselli R, et al. GERD after per-oral endoscopic myotomy as compared with Heller’s myotomy with fundoplication: a systematic review with meta-analysis. Gastrointest Endosc. 2018;87:934–43 e18.

  26. Meng F, Li P, Wang Y, et al. Peroral endoscopic myotomy compared with pneumatic dilation for newly diagnosed achalasia. Surg Endosc. 2017;31:4665–72.

  27. Zheng Z, Zhao C, Su S, et al. Peroral endoscopic myotomy versus pneumatic dilation - result from a retrospective study with 1-year follow-up. Z Gastroenterol. 2019;57:304–11.

  28. Ponds FA, Fockens P, Lei A, et al. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia: a randomized clinical trial. JAMA. 2019;322:134–44.

  29. Ramchandani M, Nabi Z, Reddy DN, et al. Outcomes of anterior myotomy versus posterior myotomy during POEM: a randomized pilot study. Endosc Int Open. 2018;6:E190–E8.

  30. Tan Y, Lv L, Wang X, et al. Efficacy of anterior versus posterior per-oral endoscopic myotomy for treating achalasia: a randomized, prospective study. Gastrointest Endosc. 2018;88:46–54.

  31. Stavropoulos SN, Xiaocen Zhang X, Khodorskiy DO, et al. Is there a difference in outcomes between anterior and posterior peroral endoscopic Myotomy (POEM)? A randomized study from an experienced high-volume operator. Gastrointest Endosc. 2018;87:AB121–AB2.

  32. Khashab MA, Sanaei O, Ponchon T, et al. Peroral endoscopic myotomy (POEM): anterior versus posterior approach, a randomized single-blinded clinical trial. Gastrointest Endosc. 2018;87: Suppl AB119.

  33. Duan T, Tan Y, Zhou J, Lv L, Liu D. A retrospective study of peroral endoscopic full-thickness myotomy in patients with severe achalasia. J Laparoendosc Adv Surg Tech A. 2017;27:770–6.

  34. Li QL, Chen WF, Zhou PH, et al. Peroral endoscopic myotomy for the treatment of achalasia: a clinical comparative study of endoscopic full-thickness and circular muscle myotomy. J Am Coll Surg. 2013;217:442–51.

  35. Wang XH, Tan YY, Zhu HY, Li CJ, Liu DL. Full-thickness myotomy is associated with higher rate of postoperative gastroesophageal reflux disease. World J Gastroenterol. 2016;22:9419–26.

  36. Mittal RK. Longitudinal muscle of the esophagus: its role in esophageal health and disease. Curr Opin Gastroenterol. 2013;29:421–30.

  37. Tanaka S, Kawara F, Abe H, et al. Significant reduction of post-operative gastroesophageal reflux development by the posterior myotomy using two penetrating vessels (TPVS) in peroral endoscopic myotomy (POEM). Gastrointest Endosc. 2018;87:AB120–AB1.

  38. Nabi Z, Reddy DN. Endoscopic management of gastroesophageal reflux disease: revisited. Clin Endosc. 2016;49:408–16.

  39. Kumta NA, Kedia P, Sethi A, Kahaleh M. Transoral incisionless fundoplication for treatment of refractory GERD after peroral endoscopic myotomy. Gastrointest Endosc. 2015;81:224–5.

  40. Tyberg A, Choi A, Gaidhane M, Kahaleh M. Transoral incisional fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal. Endosc Int Open. 2018;6:E549–E52.

  41. Inoue H, Ueno A, Shimamura Y, et al. Peroral endoscopic myotomy and fundoplication: a novel NOTES procedure. Endoscopy. 2019;51:161–4.

  42. Reddy ND. Peroral endoscopic myotomy with fundoplication: are we there yet! Endoscopy. 2019;51:111–2.

  43. Von Renteln D, Fuchs KH, Fockens P, et al. Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology. 2013;145:309–11–e1–3.

  44. Sharata AM, Dunst CM, Pescarus R, et al. Peroral endoscopic myotomy (POEM) for esophageal primary motility disorders: analysis of 100 consecutive patients. J Gastrointest Surg. 2015;19:161–70; discussion 70.

  45. Jones EL, Meara MP, Schwartz JS, Hazey JW, Perry KA. Gastroesophageal reflux symptoms do not correlate with objective pH testing after peroral endoscopic myotomy. Surg Endosc. 2016;30:947–52.

  46. Werner YB, Costamagna G, Swanstrom LL, et al. Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut. 2016;65:899–906.

  47. Chan SM, Wu JC, Teoh AY, et al. Comparison of early outcomes and quality of life after laparoscopic Heller’s cardiomyotomy to peroral endoscopic myotomy for treatment of achalasia. Dig Endosc. 2016;28:27–32.

  48. de Pascale S, Repici A, Puccetti F, Carlani E, Rosati R, Fumagalli U. Peroral endoscopic myotomy versus surgical myotomy for primary achalasia: single-center, retrospective analysis of 74 patients. Dis Esophagus. 2017;30:1–7.

  49. Hanna AN, Datta J, Ginzberg S, Dasher K, Ginsberg GG, Dempsey DT. Laparoscopic Heller myotomy vs per oral endoscopic myotomy: patient-reported outcomes at a single institution. J Am Coll Surg. 2018;226:465–472.e1.

  50. Ramirez M, Zubieta C, Ciotola F, et al. Per oral endoscopic myotomy vs. laparoscopic Heller myotomy, does gastric extension length matter? Surg Endosc. 2018;32:282–8.

Download references

Author information

Authors and Affiliations

  1. Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India

    Zaheer Nabi, Mohan Ramchandani & D. Nageshwar Reddy

Authors
  1. Zaheer Nabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohan Ramchandani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Nageshwar Reddy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zaheer Nabi.

Ethics declarations

Conflict of interest

ZN, MR, and DNR declare that they have no conflict of interest.

Disclaimer

The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers are responsible for the results/ findings and content of this article.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nabi, Z., Ramchandani, M. & Reddy, D.N. Per-oral endoscopic myotomy and gastroesophageal reflux: Where do we stand after a decade of “POETRY”?. Indian J Gastroenterol 38, 287–294 (2019). https://doi.org/10.1007/s12664-019-00980-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-019-00980-5

Keywords

Search

Navigation