Yuki B Werner1, Guido Costamagna2, Lee L Swanström3, Daniel von Renteln4, Pietro Familiari2, Ahmed M Sharata3, Tania Noder5, Guido Schachschal5, Jan F Kersten6, Thomas Rösch5. 1. Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany Department of Gastroenterology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 2. Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy. 3. Providence Cancer Center, Portland, Oregon, USA. 4. Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany Department of Gastroenterology, Centre Hospitalier de L'Université de Montreal, Montreal, Quebec, Canada. 5. Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 6. Department of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Abstract
BACKGROUND: The recently developed technique for peroral endoscopic myotomy (POEM) has been shown to be effective in several short-term studies. Longer term outcome data are largely non-existent. OBJECTIVE: To systematically report clinical outcome with a minimum post-POEM follow-up of 2 years. DESIGN: All patients treated consecutively by POEM for achalasia at three centres were retrospectively analysed, with a minimum follow-up of 2 years. The main outcome was the rate of POEM failures (Eckardt score >3) related to follow-up time. RESULTS: Of 85 patients treated, five (5.9%) cases were excluded due to protocol violation or loss to follow-up; the remaining 80 patients (mean age 44.9 years, 54% men) were followed clinically for 29 months (range 24-41). Initial clinical response was observed in 77 cases (96.3%). Clinical recurrences (later failures) were seen in a further 14 cases (17.7%), accounting for a total failure rate of 21.5%. In a multivariate analysis, age and endoscopic reflux signs were independent predictors of treatment success. Of the 17 failures, eight were among the first 10 cases treated in the participating centres. Reflux-associated sequelae included one case of a severe reflux-associated stricture requiring dilatation, and two patients with minor transient Eckardt score elevations curable by proton pump inhibitor (PPI) treatment. Endoscopic signs of reflux oesophagitis, mostly Los Angeles grade A/B, were seen in 37.5% (37/72) at the 2-year control. CONCLUSIONS: In this multicentre retrospective analysis, a high initial success rate of POEM is followed by a mid-term recurrence rate of 18%. Reflux oesophagitis, albeit mild, is frequent and should probably be treated by regular low-dose PPI therapy. TRIAL REGISTRATION NUMBER: NCT 01405417 (UKE study). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND: The recently developed technique for peroral endoscopic myotomy (POEM) has been shown to be effective in several short-term studies. Longer term outcome data are largely non-existent. OBJECTIVE: To systematically report clinical outcome with a minimum post-POEM follow-up of 2 years. DESIGN: All patients treated consecutively by POEM for achalasia at three centres were retrospectively analysed, with a minimum follow-up of 2 years. The main outcome was the rate of POEM failures (Eckardt score >3) related to follow-up time. RESULTS: Of 85 patients treated, five (5.9%) cases were excluded due to protocol violation or loss to follow-up; the remaining 80 patients (mean age 44.9 years, 54% men) were followed clinically for 29 months (range 24-41). Initial clinical response was observed in 77 cases (96.3%). Clinical recurrences (later failures) were seen in a further 14 cases (17.7%), accounting for a total failure rate of 21.5%. In a multivariate analysis, age and endoscopic reflux signs were independent predictors of treatment success. Of the 17 failures, eight were among the first 10 cases treated in the participating centres. Reflux-associated sequelae included one case of a severe reflux-associated stricture requiring dilatation, and two patients with minor transient Eckardt score elevations curable by proton pump inhibitor (PPI) treatment. Endoscopic signs of reflux oesophagitis, mostly Los Angeles grade A/B, were seen in 37.5% (37/72) at the 2-year control. CONCLUSIONS: In this multicentre retrospective analysis, a high initial success rate of POEM is followed by a mid-term recurrence rate of 18%. Reflux oesophagitis, albeit mild, is frequent and should probably be treated by regular low-dose PPI therapy. TRIAL REGISTRATION NUMBER: NCT 01405417 (UKE study). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Peter J Kahrilas; Albert J Bredenoord; Dustin A Carlson; John E Pandolfino Journal: Clin Gastroenterol Hepatol Date: 2018-04-24 Impact factor: 11.382
Authors: Ezra N Teitelbaum; Christy M Dunst; Kevin M Reavis; Ahmed M Sharata; Marc A Ward; Steven R DeMeester; Lee L Swanström Journal: Surg Endosc Date: 2017-06-29 Impact factor: 4.584
Authors: Erin K Greenleaf; Joshua S Winder; Christopher S Hollenbeak; Randy S Haluck; Abraham Mathew; Eric M Pauli Journal: Surg Endosc Date: 2017-12-07 Impact factor: 4.584
Authors: Jan Friso Nast; Christoph Berliner; Thomas Rösch; Daniel von Renteln; Tania Noder; Guido Schachschal; Stefan Groth; Harald Ittrich; Jan F Kersten; Gerhard Adam; Yuki B Werner Journal: Surg Endosc Date: 2018-03-15 Impact factor: 4.584