Clinical outcomes five years after POEM for treatment of primary esophageal motility disorders

Ezra N. Teitelbaum, Christy M. Dunst, Kevin M. Reavis, Ahmed M. Sharata, Marc A. Ward, Steven R. DeMeester, Lee L. Swanström*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

52 Scopus citations

Abstract

Background: Peroral endoscopic myotomy (POEM) is a novel operation for the treatment of achalasia and other esophageal motility disorders. While POEM has shown excellent short-term safety and efficacy, the long-term symptomatic outcomes after the procedure are unknown. Methods: Patients from a single center that underwent POEM for treatment of esophageal motility orders and were greater than 5 years removed from their operation were studied. Patients were contacted to assess current symptoms and encouraged to undergo repeat endoscopy for objective follow-up. Results: Thirty-six patients underwent POEM from October, 2010 to February, 2012 and current symptom scores were obtained from 29 patients at median 65-month follow-up. In the 23 patients with achalasia, Eckardt scores were significantly improved from preoperative baseline (mean current 1.7 vs. preoperative 6.4, p < 0.001). Nineteen patients (83%) with achalasia had a symptomatic success (Eckardt ≤3) and none required retreatment for symptoms. Eckardt scores were dramatically improved at 6 months and maintained at 2 years; however, there was a small but significant worsening of symptoms between 2 and 5-years. Of the five patients with EGJ outflow obstruction, all had current Eckardt scores ≤3 but two needed reintervention for persistent or recurrent symptoms, one with a laparoscopic Heller myotomy and another with an endoscopic cricomyotomy and proximal esophageal myotomy extension. At 6-month follow-up, repeat manometry showed decreased EGJ relaxation pressures and esophagram demonstrated improved emptying. 24-h pH monitoring showed abnormal distal esophageal acid exposure in 38% of patients. Fifteen patients underwent endoscopy at 5-years, revealing erosive esophagitis in two (13%), new hiatal hernia in two, and new non-dysplastic Barrett’s esophagus in one. The patient with Barrett’s underwent a subsequent laparoscopic hiatal hernia repair and Toupet fundoplication. Conclusions: POEM resulted in a successful palliation of symptoms in the majority of patients after 5 years, though these results emphasize the importance of long-term follow-up in all patients.

Original languageEnglish (US)
Pages (from-to)421-427
Number of pages7
JournalSurgical endoscopy
Volume32
Issue number1
DOIs
StatePublished - Jan 1 2018

Keywords

  • Achalasia
  • Endoscopic pneumatic dilation
  • Endoscopic surgery
  • Esophageal motility
  • Laparoscopic Heller myotomy
  • POEM
  • Peroral endoscopic myotomy

ASJC Scopus subject areas

  • Surgery

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