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Efficacy and Safety of Peroral Endoscopic Myotomy for Treatment of Achalasia After Failed Heller Myotomy.

Authors :
Ngamruengphong S
Inoue H
Ujiki MB
Patel LY
Bapaye A
Desai PN
Dorwat S
Nakamura J
Hata Y
Balassone V
Onimaru M
Ponchon T
Pioche M
Roman S
Rivory J
Mion F
Garros A
Draganov PV
Perbtani Y
Abbas A
Pannu D
Yang D
Perretta S
Romanelli J
Desilets D
Hayee B
Haji A
Hajiyeva G
Ismail A
Chen YI
Bukhari M
Haito-Chavez Y
Kumbhari V
Saxena P
Talbot M
Chiu PW
Yip HC
Wong VW
Hernaez R
Maselli R
Repici A
Khashab MA
Source :
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2017 Oct; Vol. 15 (10), pp. 1531-1537.e3. Date of Electronic Publication: 2017 Feb 09.
Publication Year :
2017

Abstract

Background & Aims: In patients with persistent symptoms after Heller myotomy (HM), treatment options include repeat HM, pneumatic dilation, or peroral endoscopic myotomy (POEM). We evaluated the efficacy and safety of POEM in patients with achalasia with prior HM vs without prior HM.<br />Methods: We conducted a retrospective cohort study of 180 patients with achalasia who underwent POEM at 13 tertiary centers worldwide, from December 2009 through September 2015. Patients were divided into 2 groups: those with prior HM (HM group, exposure; n = 90) and those without prior HM (non-HM group; n = 90). Clinical response was defined by a decrease in Eckardt scores to 3 or less. Adverse events were graded according to criteria set by the American Society for Gastrointestinal Endoscopy. Technical success, clinical success, and rates of adverse events were compared between groups. Patients were followed up for a median of 8.5 months.<br />Results: POEM was technically successful in 98% of patients in the HM group and in 100% of patients in the non-HM group (P = .49). A significantly lower proportion of patients in the HM group had a clinical response to POEM (81%) than in the non-HM group (94%; P = .01). There were no significant differences in rates of adverse events between the groups (8% in the HM group vs 13% in the non-HM group; P = .23). Symptomatic reflux and reflux esophagitis after POEM were comparable between groups.<br />Conclusions: POEM is safe and effective for patients with achalasia who were not treated successfully by prior HM. Although the rate of clinical success in patients with prior HM is lower than in those without prior HM, the safety profile of POEM is comparable between groups.<br /> (Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1542-7714
Volume :
15
Issue :
10
Database :
MEDLINE
Journal :
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Publication Type :
Academic Journal
Accession number :
28189695
Full Text :
https://doi.org/10.1016/j.cgh.2017.01.031