A multicenter international registry of redo per-oral endoscopic myotomy (POEM) after failed POEM

Double open per‐oral endoscopic myotomy (D‐O‐POEM) for the treatment of achalasia

“…However, a subset of patients has persistent or recurrent symptoms after the procedure. [2][3][4][5][6] Some studies 3,5,7 suggested that patient's factors (such as severe preoperative dysphagia or the presence of an achalasia-enlarged esophagus) or procedural specifics (such as early treatment failure and the formation of fibrosis or scars) were possible explanations for the failure of the procedure. After a failed POEM, repeated POEM can be performed with positive outcomes.…”

“…After the introduction of per‐oral endoscopic myotomy (POEM) which was initially carried out in patients with achalasia by Inoue et al, it has become an established treatment for achalasia due to its high feasibility and effectiveness. However, a subset of patients has persistent or recurrent symptoms after the procedure . Some studies suggested that patient's factors (such as severe preoperative dysphagia or the presence of an achalasia‐enlarged esophagus) or procedural specifics (such as early treatment failure and the formation of fibrosis or scars) were possible explanations for the failure of the procedure.…”

“…Some studies suggested that patient's factors (such as severe preoperative dysphagia or the presence of an achalasia‐enlarged esophagus) or procedural specifics (such as early treatment failure and the formation of fibrosis or scars) were possible explanations for the failure of the procedure. After a failed POEM, repeated POEM can be performed with positive outcomes . To avoid these repeated interventions, per‐oral endoscopic dual myotomy (dual POEM), in which dual myotomy are conducted during a single procedure, has become a useful method for patients with achalasia who have severe esophageal dilatation .…”

“…In a study by Li et al, 15 patients with POEM failure all achieved clinical success after a repeated POEM. Tyberg et al showed that of 46 patients who received repeated POEM, clinical success was achieved in 41 patients (85%). Recently, van Hoeij et al published data on 34 patients who had undergone retreatment.…”

The choice of myotomy in achalasia cardia: Heller's or per-oral endoscopic myotomy

“…[5] Another distinct advantage of POEM over surgical myotomy is the freedom of changing the orientation of sub-mucosal tunneling and subsequent myotomy (double tunnel POEM) in case of sub-mucosal fibrosis on one side or if the symptoms are persistent after the initial POEM. [11]…”