Gastroesophageal reflux disease after peroral endoscopic myotomy: Short-term, medium-term, and long-term resultsGastroesophageal reflux disease after peroral endoscopic myotomy (POEM)

Hernández-Mondragón, O.V.; Solórzano-Pineda, O.M.; González-Martínez, M.A.; Blancas-Valencia, Juan Manuel

doi:10.1016/j.rgmxen.2019.04.002

Cited by 5 publications

(7 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…applied the endoloop and clip method for the initial POEM‐F procedure, and refined the technique to the endoscopic hand‐suturing to avoid leaving foreign bodies in situ and found decent success in a patient with a follow‐up until 10 months 15 . The third factor which needs to be considered is that abnormal AET occurs in only around 50% of patients undergoing POEM 5,16 . In our study, patients had esophagitis on follow‐up endoscopy hence, were advised to continue PPI.…”

Section: Discussionmentioning

confidence: 78%

See 1 more Smart Citation

Early outcomes of peroral endoscopic myotomy with fundoplication for achalasia cardia – Is it here to stay?

Patil

Dalal

Maydeo

2020

Digestive Endoscopy

View full text Add to dashboard Cite

Background: Peroral endoscopic myotomy with fundoplication (POEM-F) has garnered widespread attention since it tries to achieve an appropriate antireflux procedure during the same setting. The outcomes of POEM-F are currently unexplored.Methods: Patients who underwent POEM-F at our center were retrospectively studied to assess its safety and early outcomes.Results: Twenty patients [70% male; median age 32 years (range 25-41)], with a median symptom duration of 2.1 years (range 1.5-3.7) with achalasia were included. POEM-F procedure was completed in a median of 118 min (range 90-160), with 17/20 (85%) technical success. The median hospitalization was 4 days (range 2-7). Capnothorax (n = 3), resolved spontaneously (n = 2) in 4-6 h, while in one patient (n = 1) the endoscope inadvertently entered into the thoracic cavity for which prophylactic intercostal drain was required.Capnoperitoneum was seen in 17/17 (100%) patients who underwent fundoplication, subcutaneous emphysema in 8/17 (47%) patients. At 1-month follow-up endoscopy, 5/17 (29.4%) patients had loosening of the fundal wrap, 3/17 (17.6%) patients had ulceration in fundus and in gastroesophageal junction due to underlying hemoclips. At 3 months, loosening of the fundal wrap was seen in 7/17 (41.2%) patients. A 24-h pH-metry revealed abnormal esophageal acid exposure in 7/17 (41.2%) patients, while it was normal in those patients in whom the fundal wrap was maintained. 10/17 (58.8%) patients were off proton pump inhibitors. Conclusion:POEM-F is technically feasible with reasonable short term success. However, the durability, early success and safety of POEM-F need reassessment in long-term studies before being applied in clinical practice.

show abstract

Section: Discussionmentioning

confidence: 78%

“…15 The third factor which needs to be considered is that abnormal AET occurs in only around 50% of patients undergoing POEM. 5,16 In our study, patients had esophagitis on follow-up endoscopy hence, were advised to continue PPI. On follow-up, we found the Eckardt score was <3 in all patients.…”

Section: Discussionmentioning

confidence: 89%

Early outcomes of peroral endoscopic myotomy with fundoplication for achalasia cardia – Is it here to stay?

Patil

Dalal

Maydeo

2020

Digestive Endoscopy

View full text Add to dashboard Cite

show abstract

“…A study evaluating incidence of post-POEM GERD in 68 patients over long term demonstrated that although 50% of patients reported GERD at 12 months, it was mild in most, no GERDrelated complications were noted in the 5-year follow-up post POEM, and 95% of patients were effectively controlled with proton-pump inhibitors (PPI). 34 The above-mentioned studies suggest a poor correlation between abnormal EAE, endoscopic evidence of esophagitis, and GER symptoms. Also, although abnormal acid reflux may be higher after POEM, post-POEM GER is mostly mild and nonerosive.…”

Section: The Issue Of Post-poem Germentioning

confidence: 99%

“…This raises the question whether PPI usage is directed primarily toward symptom resolution or toward healing of the esophagitis. 34,49 How long to prescribe PPI post POEM is another controversial issue. Most recent guidelines recommend PPI usage for at least 2 years post POEM.…”

Section: Treatment Of Post-poem Germentioning

confidence: 99%

Gastroesophageal Reflux after Peroral Endoscopic Myotomy: Myth or Reality?

Bapaye

Gandhi

Bapaye

2021

Journal of Digestive Endoscopy

View full text Add to dashboard Cite

Peroral endoscopic myotomy (POEM) is an accepted treatment for achalasia cardia (AC), and results are comparable to those of laparoscopic Heller myotomy (LHM). In recent years, several reports have confirmed higher incidence of gastroesophageal reflux (GER) following POEM. This review evaluates the current evidence regarding post-POEM GER, critically examines the potential contributing factors responsible for GER, limitations of the current available functional testing, and precautions and preventive measures, and provides future directions for research. Factors conclusively contributing to increased post-POEM GER include injury to the sling fibers of the lower esophageal sphincter, length of gastric myotomy > 2 cm, and others. Historically, these same factors have been implicated for development of GER after surgical (laparoscopic) myotomy. Although less invasive, optimal technique of POEM may be important to control post-POEM GER. Most post-POEM GER occurs during the immediate post-POEM period, is mild, and is easily treatable using proton-pump inhibitors. GER incidence plateaus at 2 years and is comparable to that after LHM. Patients should therefore be prescribed proton-pump inhibitors for at least 2 years. Antireflux procedures (ARPs) are infrequently required in these patients as the incidence of refractory GER is low. Novel ARPs have been recently described and are currently under evaluation. Conclusive diagnosis of GER is a clinical challenge. Most patients are asymptomatic, and GER is diagnosed only on abnormal esophageal acid exposure (EAE). Studies have demonstrated that current measures to diagnose GER are inadequate, inaccurate, and cannot differentiate between true GER and abnormal EAE due to food fermentation in the distal esophagus. The Lyon Consensus criteria should be implemented for confirmation of diagnosis of GER. Finally, the review recommends an evidence-based clinical algorithm for evaluation and management of post-POEM GER and provides guidelines for future research in this field.

show abstract

“…Symptomatic acid reflux is less common as compared to elevated acid exposure on pH testing or reflux esophagitis at endoscopy. 8,12,14,17,19,20 The incidence of symptomatic acid reflux after POEM varies widely in the literature from 8% to 29.3%. 1,2,10,17,[21][22][23][24] In a meta-analysis by Akintoye et al evaluating over 2000 patients who underwent POEM, the pooled rate of symptomatic acid reflux was 8.5% at a median of 8 months of follow up.…”

Section: Epidemiologymentioning

confidence: 99%

Management of GERD After Myotomy for Achalasia

Joelson

Sethi

2022

Foregut: The Journal of the American Foregut Society

View full text Add to dashboard Cite

Acid reflux is a well-known outcome after surgical or endoscopic myotomy, resulting from disruption of the natural anti-reflux barrier. The incidence of post-myotomy GERD remains difficult to estimate as studies cite variable definitions including endoscopic evidence of reflux, abnormal pH testing, and GERD symptoms. Future studies should focus on “clinically significant reflux” defined as abnormal pH testing associated with either GERD symptoms or endoscopic evidence of reflux esophagitis. Large meta-analyses have demonstrated significantly higher rates of abnormal acid exposure after peroral endoscopic myotomy (POEM) compared to laparoscopic heller myotomy (LHM). Focusing on POEM, studies show that while nearly half of patients will have esophagitis on follow-up endoscopy, the majority of these cases are mild or moderate and do not lead to significant clinical sequelae. While PPI therapy can be used effectively as treatment, new anti-reflux procedures are being developed, including transoral incisional fundoplication (TIF) and POEM + fundoplication (POEM + F) that may help to manage postmyotomy reflux in the same way the Dor fundoplication is performed with Heller myotomy. Currently, there is no reliable method for determining which patients are at risk for post-myotomy GERD. New methods are being developed to help risk- stratify these patients such as the use of EndoFLIP (endoscopic intraluminal functional imaging probe) to tailor the degree of myotomy. In addition, variable techniques of POEM are being studied to understand if the procedure can be performed in such a way as to minimize or even prevent post-myotomy GERD from occurring.

show abstract

Gastroesophageal reflux disease after peroral endoscopic myotomy: Short-term, medium-term, and long-term resultsGastroesophageal reflux disease after peroral endoscopic myotomy (POEM)

Cited by 5 publications

References 26 publications

Early outcomes of peroral endoscopic myotomy with fundoplication for achalasia cardia – Is it here to stay?

Early outcomes of peroral endoscopic myotomy with fundoplication for achalasia cardia – Is it here to stay?

Gastroesophageal Reflux after Peroral Endoscopic Myotomy: Myth or Reality?

Management of GERD After Myotomy for Achalasia

Contact Info

Product

Resources

About