Jun Liang Teh1,2, Hui Yu Tham1, Alex Yu Sen Soh3, Corrisa Chee1, Guowei Kim1, Asim Shabbir1, Reuben Kong Min Wong4,5, Jimmy Bok Yan So6,7. 1. Department of Surgery, National University Hospital, National University Health System, Level 8 Tower Block, 1 E Kent Ridge Road, Singapore, 119 228, Singapore. 2. Department of Surgery, JurongHealth Campus, National University Health System, Singapore, Singapore. 3. Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System, Singapore, Singapore. 4. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 5. gutCARE Digestive Liver Endoscopy Associates, Singapore, Singapore. 6. Department of Surgery, National University Hospital, National University Health System, Level 8 Tower Block, 1 E Kent Ridge Road, Singapore, 119 228, Singapore. jimmy_so@nuhs.edu.sg. 7. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. jimmy_so@nuhs.edu.sg.
Abstract
BACKGROUND: Peroral endoscopic myotomy (POEM) is gaining traction as a minimally invasive treatment of achalasia. Increased reflux is reported after POEM but the incidence, type and severity of reflux are not fully understood. We aimed to study the prevalence and nature of reflux after POEM and correlate reflux with endoscopy and pH-impedance findings. METHODS: This is a prospective cohort study of achalasia patients undergoing POEM since 2014. Data from Eckardt and GERD symptom scores, high-resolution oesophageal manometry (HRM) and gastroscopy were performed pre-procedure and repeated at 1-year follow-up. Data from 24-h pH-impedance, if performed, were also recorded. A standardized questionnaire was used to determine the severity and frequency of heartburn symptoms and the composite score for each patient was calculated. RESULTS: 58 patients underwent POEM between January 2014 and October 2018. The efficacy of POEM at 1 year was 93.0%. We observed reduction of median Integrated Relaxation Pressure (IRP) from 23.5 ± 33.1 mmHg to 13.4 ± 7.71 mmHg (p = 0.005) and mean Eckardt score improved from 6.09 ± 2.43 points to 1.16 ± 1.70 points (p < 0.001). At 1 year, 43.1% (n = 25) had symptomatic reflux. Of the 40 patients who underwent repeated gastroscopy, 60.0% (n = 24) had endoscopic evidence of oesophagitis with seven patients (18%) diagnosed with Grade C or D oesophagitis. 43.1% (n = 25) of patients had pH-impedance done post-POEM off PPIs. 14 patients (56%) had increased acid exposure. Sixteen percent of reflux episodes were acidic and 77.3% were weakly acidic. CONCLUSION: POEM was an effective treatment for achalasia. However, GERD was common after POEM with incidence of 43% on symptom score, 60% on endoscopy and 56% on pH-impedance test. Post-POEM reflux appeared to be predominantly acidic in nature. Routine surveillance for GERD after POEM is recommended.
BACKGROUND: Peroral endoscopic myotomy (POEM) is gaining traction as a minimally invasive treatment of achalasia. Increased reflux is reported after POEM but the incidence, type and severity of reflux are not fully understood. We aimed to study the prevalence and nature of reflux after POEM and correlate reflux with endoscopy and pH-impedance findings. METHODS: This is a prospective cohort study of achalasia patients undergoing POEM since 2014. Data from Eckardt and GERD symptom scores, high-resolution oesophageal manometry (HRM) and gastroscopy were performed pre-procedure and repeated at 1-year follow-up. Data from 24-h pH-impedance, if performed, were also recorded. A standardized questionnaire was used to determine the severity and frequency of heartburn symptoms and the composite score for each patient was calculated. RESULTS: 58 patients underwent POEM between January 2014 and October 2018. The efficacy of POEM at 1 year was 93.0%. We observed reduction of median Integrated Relaxation Pressure (IRP) from 23.5 ± 33.1 mmHg to 13.4 ± 7.71 mmHg (p = 0.005) and mean Eckardt score improved from 6.09 ± 2.43 points to 1.16 ± 1.70 points (p < 0.001). At 1 year, 43.1% (n = 25) had symptomatic reflux. Of the 40 patients who underwent repeated gastroscopy, 60.0% (n = 24) had endoscopic evidence of oesophagitis with seven patients (18%) diagnosed with Grade C or D oesophagitis. 43.1% (n = 25) of patients had pH-impedance done post-POEM off PPIs. 14 patients (56%) had increased acid exposure. Sixteen percent of reflux episodes were acidic and 77.3% were weakly acidic. CONCLUSION: POEM was an effective treatment for achalasia. However, GERD was common after POEM with incidence of 43% on symptom score, 60% on endoscopy and 56% on pH-impedance test. Post-POEM reflux appeared to be predominantly acidic in nature. Routine surveillance for GERD after POEM is recommended.
Authors: Salvatore Docimo; Abraham Mathew; Alexander J Shope; Joshua S Winder; Randy S Haluck; Eric M Pauli Journal: Surg Endosc Date: 2016-06-23 Impact factor: 4.584
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Authors: Yuki B Werner; Bengt Hakanson; Jan Martinek; Alessandro Repici; Burkhard H A von Rahden; Albert J Bredenoord; Raf Bisschops; Helmut Messmann; Marius C Vollberg; Tania Noder; Jan F Kersten; Oliver Mann; Jakob Izbicki; Alexander Pazdro; Uberto Fumagalli; Riccardo Rosati; Christoph-Thomas Germer; Marlies P Schijven; Alice Emmermann; Daniel von Renteln; Paul Fockens; Guy Boeckxstaens; Thomas Rösch Journal: N Engl J Med Date: 2019-12-05 Impact factor: 91.245