2016
DOI: 10.1007/s00464-016-5267-1
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Long-term outcome of peroral endoscopic myotomy for esophageal achalasia in patients with previous Heller myotomy

Abstract: POEM has a place in the treatment of esophageal achalasia in patients with a prior Heller myotomy and persistent symptoms as it is a safe procedure with acceptable long-term results.

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Cited by 40 publications
(26 citation statements)
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“…34 Of the 10 studies reporting on POEM, 3 studies (low RoB, n ¼ 2) found an association with prior treatment. 31,35,36 An increased clinical failure rate was seen in patients previously treated compared with treatment-naive patients (hazard ratio, 2.16; 95% CI, 1.44-3.24; P < .001). 31 Ngamruengphong et al 35 found that patients with a history of a Heller myotomy and pneumatic dilatation had a decreased clinical response to POEM (OR, 3.62; 95% CI, 1.26-10.39; P ¼ .02; and OR, 2.93; 95% CI, 1.15-7.43; P ¼ .02, respectively).…”
Section: Level Of Evidencementioning
confidence: 99%
See 1 more Smart Citation
“…34 Of the 10 studies reporting on POEM, 3 studies (low RoB, n ¼ 2) found an association with prior treatment. 31,35,36 An increased clinical failure rate was seen in patients previously treated compared with treatment-naive patients (hazard ratio, 2.16; 95% CI, 1.44-3.24; P < .001). 31 Ngamruengphong et al 35 found that patients with a history of a Heller myotomy and pneumatic dilatation had a decreased clinical response to POEM (OR, 3.62; 95% CI, 1.26-10.39; P ¼ .02; and OR, 2.93; 95% CI, 1.15-7.43; P ¼ .02, respectively).…”
Section: Level Of Evidencementioning
confidence: 99%
“…Another POEM study found a similar association with prior surgery and clinical failure. 36 Prior treatment as a predictive factor was explored most often (n ¼ 19) in patients treated with a laparoscopic Heller myotomy. Six studies, of which only 1 was rated as having a low risk of bias, found differences in clinical success between treatment-naive patients and patients who were treated earlier.…”
Section: Level Of Evidencementioning
confidence: 99%
“…The other systematic reviews showed that POEM is more effective than HM in terms of relieving dysphagia with short‐time follow‐up, though POEM is associated with a much higher incidence of postoperative gastroesophageal reflux disease (GERD) 15,16. Recently, some studies have shown that POEM was effective even in patients who previously failed endoscopic procedures or HM 17-31. However, the number of patients who had POEM after failed conventional endoscopic treatment or HM was limited in each study and the therapeutic yield of POEM as salvage therapy has not been well evaluated.…”
Section: Introductionmentioning
confidence: 99%
“…Per‐oral endoscopic myotomy has emerged as a less invasive treatment options for naïve as well as for prior treatment failure patients. The published literature suggests that POEM is a safe and efficacious alternative to LHM or PD for treatment of failed cases of AC . Vigneswarwan et al .…”
Section: Methodsmentioning
confidence: 99%
“…The published literature suggests that POEM is a safe and efficacious alternative to LHM or PD for treatment of failed cases of AC. 18,[92][93][94][95][96][97][98][99][100][101][102][103][104] Vigneswarwan et al concluded that POEM is feasible in failed cases of LHM, and fundoplication does not hinder successful outcomes. 92 In a recent multicenter study, the outcome of POEM was evaluated in 90 patients who underwent prior Heller's myotomy.…”
Section: Quality Of Evidence: 2+ Classification Of Recommendation: Cmentioning
confidence: 99%