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Outcomes of anterior versus posterior peroral endoscopic myotomy 2 years post-procedure: prospective follow-up results from a randomized clinical trial.

Outcomes of anterior versus posterior peroral endoscopic myotomy 2 years post-procedure: prospective follow-up results from a randomized clinical trial.

Authors :
Ichkhanian, Yervant
Abimansour, Jad P.
Pioche, Mathieu
Vosoughi, Kia
Eleftheriadis, Nicholas
Chiu, Philip Wai Yan
Minami, Hitomi
Ogihara, Kumi
Sanaei, Omid
Jovani, Manol
Khashab, Mouen A.
Source :
Endoscopy; 2021, Vol. 53 Issue 5, p462-468, 7p
Publication Year :
2021

Abstract

<bold>Background: </bold>Peroral endoscopic myotomy (POEM) is considered a primary treatment modality for achalasia. It can be performed using either the anterior or posterior approach. A previous randomized clinical trial (RCT) showed that the posterior approach was noninferior to the anterior approach at 1 year post-POEM in terms of clinical success, rate of adverse event, and risk of gastroesophageal reflux disease (GERD). The aim of this post-RCT study was to compare outcomes at ≥ 2 years post-POEM.<bold>Methods: </bold>Patients who previously completed the 1-year follow-up were contacted and their Eckardt, dysphagia, and GERD questionnaire (GERDQ) scores and frequency of proton pump inhibitor use were recorded. Clinical success was defined as an Eckardt score < 3.<bold>Results: </bold>150 patients were initially randomized and 138 completed the 1-year follow-up. Of the 138, 111 (anterior group 54, posterior group 57) also completed ≥ 2 years of follow-up, with an overall clinical success decrease from 89 % to 82 %. At ≥ 2 years post-POEM, clinical success was achieved in 46/54 (85 %) and 45/57 (79 %) in the anterior and posterior groups, respectively (P = 0.43). A similar decrease in clinical success was noted in both groups at ≥ 2 years (anterior: 90 % to 85 %; posterior 89 % to 79 %; P = 0.47). GERDQ score was 6 (interquartile range 6 - 8; P = 0.08) in both treatment groups.<bold>Conclusions: </bold>The anterior and posterior POEM techniques remained equally effective at 2 years and decreases in efficacy were similar between the two approaches over time. GERD outcomes were also similar in both groups during medium-term follow-up. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
0013726X
Volume :
53
Issue :
5
Database :
Complementary Index
Journal :
Endoscopy
Publication Type :
Academic Journal
Accession number :
149945563
Full Text :
https://doi.org/10.1055/a-1204-4242