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Endoscopy
DOI: 10.1055/a-2552-8282
Innovations and brief communications

Peroral endoscopic myotomy for symptomatic blown-out myotomy following previous myotomy for achalasia

Zhao-Chao Zhang‡
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Jia-Qi Xu‡
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Hai-Ting Pan
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Xin-Yang Liu
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Shi-Yao Chen
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Yun-Shi Zhong
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Yi-Qun Zhang
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Li-Li Ma
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Jian-Wei Hu
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Ming-Yan Cai
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Wen-Zheng Qin
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Quan-Lin Li
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Wei-Feng Chen
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Ping-Hong Zhou
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
› Author AffiliationsSupported by: Shanghai Rising-Star Program 20224Z0005
Supported by: National Natural Science Foundation of China 82170555,82270569
Supported by: Program of Shanghai Academic Research Leader 22XD1422400
Supported by: Shanghai Shuguang Program 22SG06
Supported by: Natural Science Foundation of Xiamen Municipality 3502Z20227278
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Abstract

Background

Blown-out myotomy (BOM) may impair the discharge of esophageal contents, leading to recurrent symptoms following myotomy. This study aimed to evaluate the safety and effectiveness of salvage peroral endoscopic myotomy (POEM) for symptomatic BOM.

Methods

Between August 2011 and August 2022, 77 patients with recurrent achalasia with BOM and 168 with recurrent achalasia without BOM underwent POEM and were retrospectively enrolled. Operation-related parameters were compared between the two groups.

Results

Salvage POEM was performed in patients with symptomatic BOM, with a mean procedure duration of 60.8 minutes. The mean hospital stay was 3.2 days. Procedure-related adverse events included 16 cases (20.8%) of Type I mucosal injury, 3 cases (3.9%) of Type II mucosal injury, 5 cases (6.5%) of pneumothorax, 2 cases (2.6%) of emphysema, and 2 cases (2.6%) of pneumoperitoneum. Three patients (3.9%) experienced major adverse events. No statistically significant differences were found between the two groups in the incidence of mucosal injury, gas-related adverse events, and major adverse events. Clinical success was equivalent between the two groups at the 2-year follow-up (85.7% vs. 92.3%; P = 0.16).

Conclusions

Based on this study, POEM could be considered as an effective treatment option for patients with symptomatic BOM.



Publication History

Received: 01 November 2024

Accepted after revision: 17 February 2025

Article published online:
28 March 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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