• Annals of surgery · Jun 2021

    Outcomes of 100 Patients Greater than 4 Years after POEM for Achalasia.

    • Ryan A J Campagna, Arturo Cirera, Amy L Holmstrom, Joseph R Triggs, Ezra N Teitelbaum, Dustin A Carlson, John E Pandolfino, and Eric S Hungness.
    • Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
    • Ann. Surg. 2021 Jun 1; 273 (6): 113511401135-1140.

    ObjectiveWe aim to describe the long-term follow-up data from our institution's POEM experience.Summary Background DataPer-oral endoscopic myotomy (POEM) is a well-established endoscopic therapy for achalasia with excellent short-term efficacy, but long-term outcomes data are limited.MethodsPatients older than 4 years removed from POEM for treatment of achalasia were studied. Clinical success was defined as an Eckardt Symptom (ES) score ≤3 and freedom from reintervention for achalasia. Patients underwent esophagogastroduodenoscopy (EGD), high-resolution manometry, impedance planimetry, and timed barium esophagram (TBE) preoperatively and at least 4 years postoperatively. Objective gastroesophageal reflux disease (GERD) was defined LA Grade B or worse esophagitis on EGD.ResultsOne hundred and nineteen consecutive patients were included. Five patients died or had catastrophic events unrelated to achalasia or POEM. One hundred of the remaining patients (88%, 100/114) had long-term data available. Clinical follow-up for all patients was greater than 4 years postoperatively and the mean was 55 months. Mean current ES was significantly improved from preop (n = 100, 1 ± 1 vs 7 ± 2, P < 0.001). Overall clinical success was 88% and 92%. Five patients had a current ES >3 and 4 patients required procedural reintervention on the lower esophageal sphincter. Reinterventions were successful in 75% of patients (3/4), with current ES ≤3. The rate of objective GERD was 33% (15/45). Esophageal physiology was improved with a decrease in median integrated relaxation pressure (11 ± 4 vs 33 ± 15 mm Hg, P < 0.001), a decrease in median TBE column height (3 ± 3 vs 13 ± 8 cm, P < 0.001), and an increase in median distensibility index (5.1 ± 2 vs 1.1 ± 1 mm2/mm Hg, P < 0.001).ConclusionsPOEM provides durable symptom relief and improvement in physiologic esophagogastric junction relaxation parameters over 4.5 years postoperatively. Reinterventions are rare and effective.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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