Peroral endoscopic myotomy: 10-year outcomes from a large, single-center U.S. series with high follow-up completion and comprehensive analysis of long-term efficacy, safety, objective GERD, and endoscopic functional luminal assessment

Modayil, Rani J.; Zhang, Xiaocen; Rothberg, Brooke; Kollarus, Maria M.; Galibov, Iosif; Peller, Hallie; Taylor, Sharon; Brathwaite, Collin E.; Halwan, Bhawna; Grendell, James H.; Stavropoulos, Stavros N.

doi:10.1016/j.gie.2021.05.014

Cited by 58 publications

(85 citation statements)

References 39 publications

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“…Our results suggest that in pediatric achalasia, the response to POEM is sustained for at least 4 years. The results are similar to those in adult patients in whom clinical success has been recorded in 80-95% of cases at a median follow-up ranging from 3 to 7 years (16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”

Section: Discussionsupporting

confidence: 85%

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

et al. 2022

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Background and AimPer-oral endoscopic myotomy (POEM) is emerging as an effective treatment for pediatric achalasia. There are limited data on the long-term efficacy of POEM in children and adolescents with achalasia. In this study, we aim to evaluate the outcomes of POEM at ≥4 years follow-up.MethodThe data of consecutive children who underwent POEM (September 2013–July 2021) and completed at least 4 years follow-up were analyzed retrospectively. The primary outcome was clinical success (Eckardt ≤ 3) at ≥4 years follow-up. The secondary outcomes included the prevalence of gastroesophageal reflux disease (GERD) and predictors of recurrent symptoms (Eckardt ≥2) after POEM.ResultsA total of 69 children underwent POEM for achalasia during the study period. Of these, 41 (59.4%) children completed ≥4 years [mean 68.5 months (range 48–94)] follow-up, and 38 were included in the final analysis. The subtypes of achalasia included type I (28.9%), type II (60.5%), and type III (2.6%). There was a history of prior treatment in 11 children (28.9%). Clinical success was recorded in 36 (94.7%) patients who successfully underwent POEM. Recurrent symptoms (Eckardt ≥ 2) were noticed in 12 (31.6%) children at ≥4 years. On multivariate analysis, there were no identifiable factors which predicted recurrent symptoms after POEM. Symptomatic GERD and erosive esophagitis were detected in 13.8% (4/29) and 57.1% (8/14) of the children, respectively.ConclusionPOEM is a durable treatment modality for achalasia in the pediatric population irrespective of the sub-type of achalasia and history of prior treatment.

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Section: Discussionsupporting

confidence: 85%

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

et al. 2022

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“…POEM is an established endoscopic modality of treatment for achalasia and other nonachalasia spastic esophageal motility disorders of the esophagus. [ 12 13 14 ] The safety and efficacy of POEM have been confirmed in multiple studies, and the updated societal guidelines have incorporated POEM into the management algorithm for achalasia. [ 15 16 17 18 ] Since its introduction a decade ago, several modifications have been evaluated with regard to the technique of POEM.…”

Section: Discussionmentioning

confidence: 99%

Short versus long esophageal myotomy during peroral endoscopic myotomy: A systematic review and meta-analysis of comparative trials

Nabi

Talukdar

Mandavdhare

et al. 2022

Saudi J Gastroenterol

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Background: Peroral endoscopic myotomy (POEM) is an established modality of treatment for achalasia cardia. Considerable variations exist in the technique of POEM with respect to the length and orientation of the myotomy. In this systematic review and meta-analysis, we compared the outcomes of short versus long myotomy during POEM. Methods: We searched multiple databases from January 2010 to March 2021 to identify studies reporting on POEM. We selected studies that reported on comparative outcomes of POEM using short versus long myotomy. We performed a comparative analysis of clinical success, procedural duration, gastroesophageal reflux disease (GERD), and adverse events with short and long myotomy in POEM by meta-analysis. Results: A total of 521 patients from five studies in which 241 patients were treated with short and 280 patients with long myotomy approaches were analyzed. The pooled rate for clinical success gave an odds ratio (OR) of 1.27 (95% confidence interval [CI] 0.50–3.26; I 2 = 0; P = 0.62); for hospital stay OR 0.22 (95% CI − 0.03 to 0.46; I 2 = 0; P = 0.08); for GERD by esophagogastroduodenoscopy (EGD) OR 0.58 (95% CI 0.31–1.07; I 2 = 0; P = 0.08), and for adverse events OR 0.67 (95% CI 0.29–1.53; I 2 = 51; P = 0.34). Abnormal esophageal acid exposure was less frequent with OR 0.45 (95% CI 0.22–0.90; P = 0.02; I 2 = 0) and the procedure duration was significantly shorter in the short myotomy group with OR − 0.76 (95% CI − 1.00 to − 0.52; I 2 = 43; P =0.001). Conclusion: Short myotomy and long myotomy in POEM seem comparable with each other in terms of clinical success and adverse events. Short myotomy is associated with significantly shorter procedural duration and possibly reduced esophageal acid exposure compared with long myotomy.

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“…POEM is a safe, effective, and minimally invasive treatment for esophageal motility disorders [1,9]. Secure mucosal closure is a crucial step and vital in avoiding major morbidity.…”

Section: Discussionmentioning

confidence: 99%

Through-the-scope suture closure of peroral endoscopic myotomy mucosal incision sites

et al. 2022

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Background Peroral endoscopic myotomy (POEM) is now widely used for esophageal motility disorders including achalasia. Closure of the mucosal incision site is a critical step of the procedure. We evaluated the use of a novel through-the-scope (TTS) suture system for closure of POEM mucosal incision sites. Methods We retrospectively reviewed consecutive patients who underwent POEM with TTS suture closure at our institution between February and July 2021. Technical success was defined as complete mucosal incision site closure using TTS suturing, without the need for adjunctive devices. Continuous variables are presented as median (interquartile range [IQR]) or mean (SD). Results 35 consecutive patients (median age 58 years [IQR 46.5–72]; 54.3 % female) underwent POEM with attempted mucosal closure by TTS suturing. Technical success was achieved in 32 patients (91.4 %) with a mean closure time of 12.4 (SD 6.9) minutes. The median mucosal incision length at time of closure was 2.5 cm (IQR 2–2.5). Overall, 17 patients (53.1 %) required ≥ 2 TTS suture systems and 3 patients (8.6 %) required additional TTS clips to achieve secure mucosal closure. No adverse events were encountered. Conclusions TTS suturing was effective and safe for POEM mucosotomy closure. However, prospective comparative trials and cost-effectiveness analyses are warranted before routine adoption.

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Peroral endoscopic myotomy: 10-year outcomes from a large, single-center U.S. series with high follow-up completion and comprehensive analysis of long-term efficacy, safety, objective GERD, and endoscopic functional luminal assessment

Cited by 58 publications

References 39 publications

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

Short versus long esophageal myotomy during peroral endoscopic myotomy: A systematic review and meta-analysis of comparative trials

Through-the-scope suture closure of peroral endoscopic myotomy mucosal incision sites

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