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

Teitelbaum, Ezra N.; Dunst, Christy M.; Reavis, Kevin M.; Sharata, Ahmed; Ward, Marc A.; DeMeester, Steven R.; Swanström, Lee L.

doi:10.1007/s00464-017-5699-2

Cited by 132 publications

(126 citation statements)

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“…In the only systematic review of 8 studies (n = 184 patients) examining medical, endoscopic, and surgical management of EGJOO, no POEM cases were included. Of note, in this study, botulinum toxin injection and expectant management were the two most frequent approaches, with success rates being 58 % and 54 %, respectively [6] There have been a few retrospective studies examining the role of POEM in non-achalasia esophageal motility disorders [7][8][9][10][11][12]. Collectively they have included a total of 3 patients with EGJOO who underwent POEM with promising technical and clinical efficacy; however, these retrospective studies also included other non-achalasia dysmotility disorders in their cohort and are limited by heterogeneous diagnostic and clinical efficacy assessment.…”

Section: Introductionmentioning

confidence: 72%

Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial

et al. 2020

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Background and study aims Esophagogastric junction outflow obstruction (EGJOO) is a rare esophageal dysmotility disease that is characterized by elevated integrated relaxation pressuse (IRP) with evidence of preserved peristalsis. The role of peroral endoscopic myotomy (POEM) in management of EGJOO is currently unknown. Patients and methods This is a prospective trial conducted in a single US tertiary care center from June 2015 to June 2019. Symptomatic patients, diagnosed with EGJOO on both HRM and endoluminal functional lumen imaging probe (EndoFLIP), who were eligible for POEM were recruited. Primary outcome was clinical success, defined as Eckardt score (ES) ≤ 3, at 6 months post-POEM. Other outcomes included dysphagia score, quality of life as measured by 36-item Short Form health survey scales (SF-36), post-POEM HRM, EndoFLIP, and pH measurements, and adverse events. Results A total of 15 patients (51.8 yr. 9 F) with EGJOO underwent POEM. Pre-POEM mean IRP on HRM and Distensibility index (DI) on EndoFLIP were 24.3 ± 2.2 mmHg and 1.1 ± 0.6 mm2/mmHg, respectively. Clinical success was achieved in 93 % at 6 months post-POEM. There was significant decrease in IRP (-17.6 mmHg) post-POEM. There was significant improvement at 6 months in two of the SF-36 subscales. Ten patients underwent post-POEM pH testing, seven of whom had abnormal DeMeester score. Seven patients underwent EGD evaluation revealing esophagitis in five (2 Los Angeles grade A and 3 grade B). Conclusions POEM offers a high clinical success rate for patients with EGJOO confirmed by impedance planimetry.

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Section: Introductionmentioning

confidence: 72%

Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial

et al. 2020

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“…Teitelbaum et al . reported that clinical success (Eckardt score ≤2) was 83% at post‐5 years . Further studies with long‐term follow up including larger sample sizes are needed.…”

Section: Clinical Questions and Statementsmentioning

confidence: 99%

Clinical practice guidelines for peroral endoscopic myotomy

Inoue

Shiwaku

Iwakiri

et al. 2018

Digestive Endoscopy

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Peroral endoscopic myotomy (POEM) is a novel clinical technique developed in Japan used to treat esophageal achalasia and esophageal motility disorders. This technique has been rapidly accepted and widely disseminated throughout our clinical practice because of its low invasiveness, technical novelty, and high efficacy. Since the advent of POEM, there have been no clinical guidelines that clearly indicated its standard of care, and these guidelines have been anticipated both nationally and internationally by clinicians who engage in POEM practice. In 2017, to meet these needs, the Japan Gastroenterological Endoscopy Society (JGES) launched the guideline committee for POEM. Based on the guideline development process proposed by the Medical Information Network Distribution Service (MINDS), the guideline committee initially created research questions on POEM and conducted a systematic review and meta-analysis on each topic. The clinical research extracted from databases for these clinical questions and the systematic review mainly comprised a few retrospective studies with a small number of participants and short trial periods; hence, the strength of the evidence and recommendations derived from these results was low. Throughout this process, the guideline committee met thrice: once on May 13, 2017, and again on September 17, 2017, to formulate the draft. A consensus meeting was then held on January 14, 2018, in Tokyo to establish the guideline statements and finalize the recommendations using the modified Delphi method. This manuscript presents clinical guidelines regarding current standards of practice and recommendations in terms of the nine chief topics in POEM.

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“…A single-center clinical study from China demonstrated that the long-term clinical success after POEM decreased slightly over time [12], with clinical success dropping from 94 % at 1 year to 87 % at 5 years. Recently, Teiltembaum et al reported a single-center experience 5 years after POEM in 36 patients; 83 % of patients with achalasia had symptomatic success (Eckardt ≤ 3) at 6 months and maintained at 2 years; however, there was a small but significant worsening of symptoms between 2 and 5 years [13]. Available data compare favorably to laparoscopic Heller myotomy (LHM) with clinical success reported to be 76.1 % at 5 years [14].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study

et al. 2020

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Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clinical response of 82 % to 100 % in treatment of patients with achalasia. Data are limited on the long-term durability of the clinical response in these patients. The aim of this study was to determine the long-term outcomes of patients undergoing POEM for management of achalasia. Methods This was a retrospective multicenter cohort study of consecutive patients who underwent POEM for management of achalasia. Patients had a minimum of 4 years follow-up. Clinical response was defined by an Eckardt score ≤ 3. Results A total of 146 patients were included from 11 academic medical centers. Mean (± SD) age was 49.8 (± 16) years and 79 (54 %) were female. The most common type of achalasia was type II, seen in 70 (47.9 %) patients, followed by type I seen in 41 (28.1 %) patients. Prior treatments included: pneumatic dilation in 29 (19.9 %), botulinum toxin injection in 13 (8.9 %) and Heller myotomy in seven patients (4.8 %). Eight adverse events occurred (6 mucosotomies, 2 pneumothorax) in eight patients (5.5 %). Median follow-up duration was 55 months (IQR 49.9–60.6). Clinical response was observed in 139 (95.2 %) patients at follow-up of ≥ 48 months. Symptomatic reflux after POEM was seen in 45 (32.1 %) patients, while 35.3 % of patients were using daily PPI at 48 months post POEM. Reflux esophagitis was noted in 16.8 % of patients who underwent endoscopy. Conclusion POEM is a durable and safe procedure with an acceptably low adverse event rate and an excellent long-term clinical response.

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

Abstract: 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.

Cited by 132 publications

References 25 publications

Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial

Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial

Clinical practice guidelines for peroral endoscopic myotomy

Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study

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