Long-Term Efficacy of Peroral Endoscopic Myotomy for Patients with Achalasia: Outcomes with a Median Follow-Up of 36 Months

He, Chenghai; Li, Meng; Lü, Bin; Ying, Xiaofang; Gao, Chen; Wang, Shuangshuang; Ma, Chengao; Jin, Chaoqiong

doi:10.1007/s10620-018-5373-0

Cited by 34 publications

(64 citation statements)

References 34 publications

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“…With a mean follow-up of 33.39 months, the therapeutic success (87.5%) we achieved seems to remain steady, proving that POEM is a safe and effective long-term procedure. Our results are similar to other studies where symptom relief was noted in 82.4-91.3% of patients [24,41,47].…”

Section: Discussionsupporting

confidence: 92%

“…Side effects associated with insufflation are frequently asymptomatic and have an incidence between 0% and 72% [3]. If symptomatic, pneumoperitoneum or pneumothorax can be drained, whereas subcutaneous emphysema rarely needs to be treated [3,9,10,42,47,48]. In our study, CO2 was used in all interventions, which has contributed to the absence of symptoms in most patients, as it is easily and hastily absorbed.…”

Section: Discussionmentioning

confidence: 84%

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POEM: Five Years of Experience in a Single East European Center

Tefas

Boroș²,

Ciobanu

et al. 2020

JGLD

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Background and Aims: Achalasia is an esophageal motility disorder with many available therapies. Peroral endoscopic myotomy (POEM) is a therapeutic alternative to surgical myotomy, harboring significant potential short term advantages. Our aim was to analyze a single-series POEM’s learning curve, safety and efficiency over short, medium and long-terms in an East European Center. Methods: This observational, prospective study was carried out in the Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. Patients with symptomatic achalasia (Eckardt score>3) and pre-op evaluations consistent with the diagnosis of achalasia were included. All POEMs were performed by a highly skilled endoscopist. All patients were allowed to eat 48 hours after POEM. An esophagography was performed in all patients to exclude any leakage. The patients were asked to return for follow-up at established intervals: 1 month, 6 months, 12 months, and annually thereafter. Results: 136 patients were included with an average duration of symptomatology of 36.75 months. The procedure was technically successful in all patients, while a clinical success rate was achieved in 87.5% (n=119) of patients after one POEM session. The success rate was 92.64% after 6 months, 91.17% after one year, 88.9% after 2 years, and 87.5% after 3 years or more; 12.5% of patients required additional treatment. Eighteen patients (13.23%) presented major early complications. Gastroesophageal reflux disease was encountered in 16 patients immediately after POEM and in 22 patients at subsequent follow-ups. Conclusion: POEM is a safe and effective minimally invasive therapeutic option which can substitute surgical myotomy, having a high success rate and a low rate of adverse events in short, medium and long-term.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 84%

POEM: Five Years of Experience in a Single East European Center

Tefas

Boroș²,

Ciobanu

et al. 2020

JGLD

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“…Inoue et al reported a durable clinical success of 88.5 % at 3 years in 61 patients whereas Li et al reported a drop in the long-term durability of the early clinical success of POEM in only 48 of 562 patients, with 87 % having a clinical response at ≥ 4 years. The tendency toward decreased efficacy in the long-term following POEM [5,9,12,[18][19][20][21][22] is also apparent in LHM [23]. The study published in 2018 by Teitelbaum et al also showed a decrease in the clinical success rate ▶ of POEM in Achalasia patients to around 83 % at 5 years followup.…”

Section: Discussionmentioning

confidence: 96%

“…This was a retrospective, international, multicenter cohort study including 11 tertiary centers (2 from the United States, 7 from Europe, 2 from Asia). The total number of patients contributed by each center were as follows: Gemelli University Hospital, Italy (101), Hirslanden Private Clinic Group, Zürich (19), Deenanath Mangeshkar Hospital, India (18), Johns Hopkins Hospital, US (17), Edouard Herriot hospital, France (13), CHA Bundang Hospital, South Korea (7), Cochin Hospital, France (6), Metropolitan Hospital, Greece (5), Kingʼs College Hospital, UK (3), Iuliu Haţieganu University of Medicine and Pharmacy, Romania (2), NorthShore University HealthSystem, United States (2). Institutional Review Board approval was obtained at all institutions for chart review and patient follow-up.…”

Section: Methodsmentioning

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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“…Male sex was also a risk factor for recurrence, although the large confidence interval may indicate that this was a result of a sampling error. Besides, the extent of myotomy was not associated with POEM prognosis[ 25 ]. Therefore, our result is still reliable, although we are not able to discuss the effect of the degree of myotomy on prognosis after POEM as all patients enrolled underwent myotomy of the same degree in this study.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-measured muscular thickness of the lower esophageal sphincter and long-term prognosis after peroral endoscopic myotomy for achalasia

Liao

Xiao

et al. 2020

WJG

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BACKGROUND People with achalasia typically have a thick lower esophageal muscularis propria (LEMP), and peroral endoscopic myotomy (POEM) has been effective in treating most patients. LEMP thickness may be associated with the outcomes and prognosis after POEM. However, more evidence is needed regarding the relationship between LEMP thickness and patient prognosis after POEM. AIM To assess the association between LEMP thickness, measured using endoscopic ultrasound (EUS), and long-term prognosis, especially relapse, after POEM for achalasia. METHODS All medical records, including EUS data, of patients who underwent POEM to treat achalasia at Shengjing Hospital of China Medical University from January 2012 to September 2018 were retrospectively reviewed. LEMP thickness was measured by EUS, and a thickness of ≥ 3 mm was defined as thickened. The severity of patient symptoms was evaluated using the Eckardt score. Relapse was defined as a 3-point rise in the Eckardt score after a period of clinical remission. The relationship between patient characteristics, muscle thickness, and recurrence was analyzed. RESULTS Eighty-two patients (32 males and 50 females, aged 17-78 years) and 85 POEM procedures were included. In total, 76.8% (63/82 patients) of patients had a thickened muscularis propria. Older age and longer disease course were associated with muscularis propria thickening ( P < 0.05). The mean postoperative follow-up time was 35.4 ± 17.2 mo (range, 8-87.5 mo) in 60 patients. Five patients with Eckardt scores > 3 refused further management after their symptoms were relieved. The relapse rate was 12.73% (7/55 cases). Five patients, four of whom had muscularis propria thickening, had disease recurrence within 12 mo after the procedure. Achalasia relapsed in one patient who had a thickened muscularis propria after 24 mo and in another patient who did not have a thickened muscularis propria after 30 mo. Patients with recurrence were typically younger and had a shorter disease course ( P < 0.05). The relapse rate in patients with a non-thickened muscularis propria tended to be higher (18.2%, 2/11 patients) than that in patients with a thickened muscularis propria (11.4%, 5/44 patients), although no significant difference was found. Age (hazard ratio = 0.92; 95% confidence interval: 0.865-0.979; P < 0.05) and being male (hazard ratio = 7.173; 95% confidence interval: 1.277-40.286; P < 0.05) were identified as risk factors for symptomatic recurrence by multivariable analysis using the Cox model. CONCLUSION Patients with a thickened muscularis are typically older and have a longer disease course. Younger age and the male sex are associated with increased recurrence. Patients with a thin muscularis propria may be prone to relapse, although further validation is needed.

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Long-Term Efficacy of Peroral Endoscopic Myotomy for Patients with Achalasia: Outcomes with a Median Follow-Up of 36 Months

Cited by 34 publications

References 34 publications

POEM: Five Years of Experience in a Single East European Center

POEM: Five Years of Experience in a Single East European Center

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

Endoscopic ultrasound-measured muscular thickness of the lower esophageal sphincter and long-term prognosis after peroral endoscopic myotomy for achalasia

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