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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(03): E409-E416
DOI: 10.1055/a-1333-1883
Original article

Long-term clinical results of per-oral endoscopic myotomy (POEM) for achalasia: First report of more than 10-year patient experience as assessed with a questionnaire-based survey

Manabu Onimaru
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Haruhiro Inoue
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Yusuke Fujiyoshi
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Mary Raina Angeli Abad
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Yohei Nishikawa
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Akiko Toshimori
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Yuto Shimamura
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Mayo Tanabe
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Kazuya Sumi
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
,
Haruo Ikeda
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
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Abstract

Background and study aims Since per-oral endoscopic myotomy (POEM) was introduced in 2010, it has become accepted as one of the standard treatments for esophageal achalasia worldwide. This study aimed to present long-term clinical results of POEM over 10 years and evaluate the technique and outcomes at the institution where it was first used in clinical settings.

Patients and methods Questionnaire-based surveys were sent to patients who received POEM in our institution from September 2008 to May 2010. Patient demographics and procedural outcomes and open-ended questions were posed about the postoperative courses, including symptom improvement and recurrence, additional treatments, and post-POEM gastroesophageal reflux disease (GERD) symptoms. Achalasia symptoms and post-POEM GERD symptoms were evaluated with Eckhardt scores and GerdQ systems, respectively.

Results Thirty-six consecutive POEMs were performed in that period and 10-year follow-up data were obtained from 15 patients (41.7 %). Although four cases (26.7 %) required additional pneumatic balloon dilatation (PBD), reduction in post-Eckardt scores were observed in 14 cases (93.3 %). GerdQ score was positive in one patient (6.7 %). Proton pump inhibitors (PPI) were taken by four patients (26.7 %) and their symptoms were well-controlled.

Conclusions Clinical results of POEM over 10 years were favorable regardless of various factors. Symptoms improved even in patients who required additional treatments, suggesting that POEM plays a significant role in treatment of achalasia.



Publication History

Received: 24 September 2020

Accepted: 02 November 2020

Article published online:
19 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
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Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2021; 53(04): 458-458
DOI: 10.1055/a-1346-4865

 

  • References

  • 1 Inoue H, Minami H, Kobayashi Y. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Inoue H, Shiwaku H, Iwakiri K. et al. Clinical practice guidelines for peroral endoscopic myotomy. Dig Endosc 2018; 30: 563-579
    CrossrefPubMedGoogle Scholar
  • 3 Zaninotto G, Bennett C, Boeckxstaens G. et al. The 2018 ISDE achalasia guidelines. Dis Esophagus 2018; 31: 1-29
    CrossrefPubMedGoogle Scholar
  • 4 Kahrilas PJ, Katzka D, Richter JE. Clinical Practice Update: The Use of Per-Oral Endoscopic Myotomy in Achalasia: Expert Review and Best Practice Advice From the AGA Institute. Gastroenterology 2017; 153: 1205-1211
    CrossrefPubMedGoogle Scholar
  • 5 Shiwaku H, Inoue H, Sato H. et al. Peroral endoscopic myotomy for achalasia: a prospective multicenter study in Japan. Gastrointest Endosc 2020; 91: 1037-1044, e1032
    CrossrefPubMedGoogle Scholar
  • 6 Inoue H, Shiwaku H, Kobayashi Y. et al. Statement for gastroesophageal reflux disease after peroral endoscopic myotomy from an international multicenter experience. Esophagus 2020; 17: 3-10
    CrossrefPubMedGoogle Scholar
  • 7 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: 934-943, e918
    CrossrefPubMedGoogle Scholar
  • 8 Grimes KL, Inoue H, Onimaru M. et al. Double-scope per oral endoscopic myotomy (POEM): a prospective randomized controlled trial. Surg Endosc 2016; 30: 1344-1351
    CrossrefPubMedGoogle Scholar
  • 9 Rieder E, Swanstrom LL, Perretta S. et al. Intraoperative assessment of esophagogastric junction distensibility during per oral endoscopic myotomy (POEM) for esophageal motility disorders. Surg Endosc 2013; 27: 400-405
    CrossrefPubMedGoogle Scholar
  • 10 Li QL, Wu QN, Zhang XC. et al. Outcomes of per-oral endoscopic myotomy for treatment of esophageal achalasia with a median follow-up of 49 months. Gastrointest Endosc 2018; 87: 1405-1412, e1403
    CrossrefPubMedGoogle Scholar
  • 11 Teitelbaum EN, Dunst CM, Reavis KM. et al. Clinical outcomes five years after POEM for treatment of primary esophageal motility disorders. Surg Endosc 2018; 32: 421-427
    CrossrefPubMedGoogle Scholar
  • 12 Jones R, Junghard O, Dent J. et al. Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther 2009; 30: 1030-1038
    CrossrefPubMedGoogle Scholar
  • 13 Japan Esophageal Society. Descriptive Rules for Achalasia of the Esophagus, 4th Edition. Esophagus 2017; 14: 275-289
    CrossrefPubMedGoogle Scholar
  • 14 Woltman TA, Pellegrini CA, Oelschlager BK. Achalasia. Surg Clin North Am 2005; 85: 483-493
    CrossrefPubMedGoogle Scholar
  • 15 Chandan S, Mohan BP, Chandan OC. et al. Clinical efficacy of per-oral endoscopic myotomy (POEM) for spastic esophageal disorders: a systematic review and meta-analysis. Surg Endosc 2020; 34: 707-718
    CrossrefPubMedGoogle Scholar
  • 16 Pasricha PJ, Hawari R, Ahmed I. et al. Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia. Endoscopy 2007; 39: 761-764
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Chone A, Familiari P, von Rahden B. et al. Multicenter evaluation of clinical efficacy and safety of per-oral endoscopic myotomy in children. J Pediatr Gastroenterol Nutr 2019; 69: 523-527
    CrossrefPubMedGoogle Scholar
  • 18 Sanaka MR, Chadalavada P, Alomari M. et al. Peroral endoscopic myotomy is a safe and effective treatment modality for geriatric patients with achalasia. Esophagus 2020; 17: 484-491
    CrossrefPubMedGoogle Scholar
  • 19 Hu JW, Li QL, Zhou PH. et al. Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study. Surg Endosc 2015; 29: 2841-2850
    CrossrefPubMedGoogle Scholar
  • 20 Nabi Z, Ramchandani M, Sayyed M. et al. Comparison of short versus long esophageal myotomy in cases with idiopathic achalasia: a randomized controlled trial. J Neurogastroenterol Motil 2020; DOI: 10.5056/jnm20022.
    CrossrefPubMedGoogle Scholar
  • 21 Khashab MA, Sanaei O, Rivory J. et al. Peroral endoscopic myotomy: anterior versus posterior approach: a randomized single-blinded clinical trial. Gastrointest Endosc 2020; 91: 288-297, e287
    CrossrefPubMedGoogle Scholar
  • 22 Oude Nijhuis RAB, Prins LI, Mostafavi N. et al. Factors associated with achalasia treatment outcomes: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2020; 18: 1442-1453
    CrossrefPubMedGoogle Scholar
  • 23 Ren Y, Tang X, Chen Y. et al. Pre-treatment Eckardt score is a simple factor for predicting one-year peroral endoscopic myotomy failure in patients with achalasia. Surg Endosc 2017; 31: 3234-3241
    CrossrefPubMedGoogle Scholar
  • 24 Liu ZQ, Li QL, Chen WF. et al. The effect of prior treatment on clinical outcomes in patients with achalasia undergoing peroral endoscopic myotomy. Endoscopy 2019; 51: 307-316
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 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-E201
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Nabi Z, Ramchandani M, Kotla R. et al. Gastroesophageal reflux disease after peroral endoscopic myotomy is unpredictable, but responsive to proton pump inhibitor therapy: a large, single-center study. Endoscopy 2020; 52: 643-651
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Kumbhari V, Familiari P, Bjerregaard NC. et al. Gastroesophageal reflux after peroral endoscopic myotomy: a multicenter case-control study. Endoscopy 2017; 49: 634-642
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Grimes KL, Bechara R, Shimamura Y. et al. Gastric myotomy length affects severity but not rate of post-procedure reflux: 3-year follow-up of a prospective randomized controlled trial of double-scope per-oral endoscopic myotomy (POEM) for esophageal achalasia. Surg Endosc 2020; 34: 2963-2968
    CrossrefPubMedGoogle Scholar
  • 29 Wang XH, Tan YY, Zhu HY. et al. Full-thickness myotomy is associated with higher rate of postoperative gastroesophageal reflux disease. World J Gastroenterol 2016; 22: 9419-9426
    CrossrefPubMedGoogle Scholar
  • 30 Mota RCL, de Moura EGH, de Moura DTH. et al. Risk factors for gastroesophageal reflux after POEM for achalasia: a systematic review and meta-analysis. Surg Endosc 2020; DOI: 10.1007/s00464-020-07412-y.
    CrossrefPubMedGoogle Scholar