Long-term outcome of peroral endoscopic myotomy for esophageal achalasia in patients with previous Heller myotomy

• Published in: Surgical endoscopy Vol. 31; no. 6; pp. 2596 - 2601
• Main Authors: Kristensen, Helle Ø., Kirkegård, Jakob, Kjær, Daniel Willy, Mortensen, Frank Viborg, Kunda, Rastislav, Bjerregaard, Niels Christian
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2017; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Endoscopy; Esophageal Achalasia - surgery; Esophageal Sphincter, Lower - surgery; Esophagus; Female; Gastroenterology; Gynecology; Heller Myotomy; Hepatology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Natural Orifice Endoscopic Surgery; Proctology; Reoperation; Surgery; Treatment Outcome; Young Adult; Heller myotomy; Motility disorder; Achalasia; POEM; Peroral endoscopic myotomy; Esophagus
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-016-5267-1

Background Peroral endoscopic myotomy (POEM) is an emerging procedure in the treatment of esophageal achalasia, a primary motility disorder. However, the long-term outcome of POEM in patients, who have previously undergone a Heller myotomy, is unknown. Methods Using a local database, we identified patients with esophageal achalasia, who underwent POEM. We compared patients with a previous Heller myotomy to those, who had received none or only non-surgical therapy prior to the POEM procedure. We conducted follow-up examinations at 3, 12, and 24 months following the procedure. Results We included 66 consecutive patients undergoing POEM for achalasia, of which 14 (21.2 %) had undergone a prior Heller myotomy. In both groups, the preoperative Eckardt score was 7. Postoperatively, the non-Heller group experienced a more pronounced symptom relief at both 3-, 12-, and 24-month follow-up compared with the Heller group, and there was a tendency for the effect of POEM to reduce over time. We suggest that there is a correlation between preoperative measurements of gastroesophageal sphincter pressures and the chance of a successful POEM. Conclusions POEM has a place in the treatment of esophageal achalasia in patients with a prior Heller myotomy and persistent symptoms as it is a safe procedure with acceptable long-term results.