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- Title
Clinical outcomes five years after POEM for treatment of primary esophageal motility disorders.
- Authors
Teitelbaum, Ezra N.; Dunst, Christy M.; Reavis, Kevin M.; Sharata, Ahmed M.; Ward, Marc A.; DeMeester, Steven R.; Swanström, Lee L.
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
MUSCLES; ESOPHAGEAL achalasia; ENDOSCOPY; PREOPERATIVE care; SURGERY; THERAPEUTICS; ESOPHAGEAL surgery; ORAL surgery; ESOPHAGEAL motility disorders; GASTROSCOPY; LONGITUDINAL method; TREATMENT effectiveness; SEVERITY of illness index
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2018, Vol 32, Issue 1, p421
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-017-5699-2