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

• Published in: Surgical endoscopy Vol. 32; no. 1; pp. 421 - 427
• Main Authors: Teitelbaum, Ezra N., Dunst, Christy M., Reavis, Kevin M., Sharata, Ahmed M., Ward, Marc A., DeMeester, Steven R., Swanström, Lee L.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2018; Springer Nature B.V
• Subjects: Abdominal Surgery; Clinical outcomes; Endoscopy; Esophageal diseases; Esophagus; Gastroenterology; Gynecology; Hepatology; Hernias; Laparoscopy; Medicine; Medicine & Public Health; Motility; Proctology; Surgery; Esophageal motility; Endoscopic surgery; POEM; Laparoscopic Heller myotomy; Peroral endoscopic myotomy; Endoscopic pneumatic dilation; Achalasia
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-017-5699-2

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.