Long-term clinical evaluation of a decade with peroral endoscopic myotomy at a single European tertiary center
Language English Country United States Media print-electronic
Document type Journal Article
PubMed
39321890
DOI
10.1016/j.gie.2024.09.027
PII: S0016-5107(24)03509-0
Knihovny.cz E-resources
- MeSH
- Esophageal Achalasia * surgery physiopathology MeSH
- Time Factors MeSH
- Tertiary Care Centers MeSH
- Esophageal Sphincter, Lower * surgery MeSH
- Adult MeSH
- Natural Orifice Endoscopic Surgery * methods MeSH
- Fluoroscopy MeSH
- Gastroesophageal Reflux * etiology epidemiology MeSH
- Gastroscopy MeSH
- Quality of Life MeSH
- Middle Aged MeSH
- Humans MeSH
- Manometry MeSH
- Esophageal pH Monitoring MeSH
- Follow-Up Studies MeSH
- Postoperative Complications * epidemiology MeSH
- Pyloromyotomy * methods MeSH
- Recurrence MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND AND AIMS: Peroral endoscopic myotomy (POEM) is an established treatment for achalasia with compelling midterm efficacy. In this study, we analyzed the long-term efficacy, sought predictors of failure, and comprehensively assessed post-POEM reflux. METHODS: We performed a retrospective analysis of a prospective database of patients undergoing POEM at a high-volume center from December 2012 to June 2023. Patients who had completed a 3-month follow-up were included. Efficacy was assessed at 3, 6, and 8 years using the Eckardt score (ES). An ES ≤2 was considered treatment success. At 3 months, gastroscopy, manometry, 24-hour pH monitoring, and fluoroscopy were performed, and gastroscopy was repeated at 2 and 3 years. At each visit, patients were assessed for reflux symptoms and quality of life. RESULTS: From 496 included patients, 3-, 6-, and 8-year follow-ups were completed in 302, 115, and 40 patients, respectively. The treatment success rates at 3, 6, and 8 years according to the Kaplan-Meier analysis were 90.2% (95% confidence interval [CI], 87.2-93.3), 82.3% (95% CI, 77.3-87.6), and 73.5% (95% CI, 64.8-83.5), respectively. Year of procedure was the only predictor of outcome. Fifty-three patients (10.7%) encountered failure or recurrence. Treatment success of redo-POEM (n = 20) at 1 year was significantly lower (62.9% [95% CI, 44.3-89.2] vs 96.9% [95% CI, 95.3-98.5], P < .001). At 3 months, 40.4% of patients had reflux esophagitis (RE), 43.6% of patients had an acid exposure time >4.5%, 39.2% of patients were using proton pump inhibitors (PPIs), but only 24.2% had reflux symptoms. At 2 to 3 years, 50.8% of patients took PPIs, whereas 39.6% were symptomatic. RE decreased to 20.2% at 6 years. CONCLUSIONS: The treatment success of POEM declines over time but remains sufficiently high in the long term. Experience with the procedure improves the outcome. Gastroesophageal reflux affects almost half of patients early after POEM and decreases substantially over time together with a rise in PPI use.
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