Peroral endoscopic myotomy leads to higher rates of abnormal esophageal acid exposure than laparoscopic Heller myotomy in achalasia

Sanaka, Madhusudhan R.; Thota, Prashanthi N.; Parikh, Malav P.; Hayat, Umar; Gupta, Neena; Gabbard, Scott; López, Rocío; Murthy, Sudish C.; Raja, Siva

doi:10.1007/s00464-018-6522-4

Cited by 58 publications

(35 citation statements)

References 17 publications

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“…However, when reflux was measured by pH monitoring, it was present in 11% of patients after LHM but in 48% of patients after POEM. The findings of these retrospective studies 14,16 have been recently confirmed by the first prospective and randomized trial comparing LHM with fundoplication to POEM. 17 In this multicenter study, Werner et al documented clinical success in 81% of patients after LHM and 83% after POEM.…”

Section: Discussionmentioning

confidence: 72%

Antireflux Surgery for Gastroesophageal Reflux Refractory to Medical Treatment After Peroral Endoscopic Myotomy

Nurczyk

Farrell

Patti

2020

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: Between 1995 and 2010, the laparoscopic Heller myotomy (LHM) was considered in most centers the treatment of choice for esophageal achalasia. The technique evolved over time, and the initial thoracoscopic approach was abandoned in favor of LHM with the addition of a fundoplication, due to the high incidence of postoperative reflux. Recently, a new endoscopic technique has been adopted in the treatment of achalasia-peroral endoscopic myotomy (POEM), which has slowly become the preferred treatment modality in many centers. While POEM is as effective as LHM in relieving symptoms, it has been associated with a very high rate of pathological reflux, development of strictures, Barrett's esophagus, and adenocarcinoma. In addition, many patients still complain of heartburn and regurgitation even when treated with high doses of proton pump inhibitors. Methods: We described 3 cases of achalasia patients with reflux symptoms refractory to medical treatment after POEM who underwent laparoscopic antireflux surgery. Results: The operations were completed laparoscopically despite presence of mediastinal adhesions, probably secondary to micro-leaks during POEM. All patients had resolution of their symptoms. Conclusions: This is the first report that describes patients who developed severe heartburn and regurgitation refractory to medical treatment following POEM, who eventually underwent a laparoscopic partial fundoplication with resolution of their symptoms. Our experience shows that post-POEM reflux is a serious concern, especially when refractory to medical treatment. We feel that this is a worrisome problem that will require frequent surgical interventions in the future.

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Section: Discussionmentioning

confidence: 72%

Antireflux Surgery for Gastroesophageal Reflux Refractory to Medical Treatment After Peroral Endoscopic Myotomy

Nurczyk

Farrell

Patti

2020

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…Compared to the Heller myotomy, the incidence of GERD is higher in most reports, although few reports suggest that there is no difference [34,36]. In addition, POEM can lead to significant increase in abnormal esophageal acid exposure rate while the incidence of GERD symptoms do not [48] and it may be due to the reason that POEM does not combine with laparoscopic fundoplication. In order to overcome the higher incidence of GERD.…”

Section: Complicationsmentioning

confidence: 98%

Peroral endoscopic myotomy for esophageal motility disorders

et al. 2019

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Background Esophageal motility disorders which include achalasia, esophagogastric junction outflow obstruction (EGJ outflow obstruction), jackhammer esophagus (JE), distal esophageal spasm (DES), etc. are rare disease of unknown causes. The diagnosis is based on endoscopy, barium meal, and high-resolution manometry (HRM). With the development of endoscopy, peroral endoscopic myotomy (POEM) has emerged as a standard method for the treatment of achalasia. Purpose The purpose of this article is to enable gastroenterologists to have a more comprehensive understanding of the application status, technical characteristics, clinical efficacy and future prospect of POEM in the treatment of esophageal motility disorders. Methods Through a large number of reading literature, combined with clinical practice, summary and analysis of the indications, procedure, efficacy, complications, and controversies of POEM in the treatment of esophageal motility disorders, as well as the current and future perspectives of POEM were studied. Results POEM is safe and effective in the treatment of esophageal motility disorders, but the GERD reflux rate is higher. Conclusions POEM can be a new option for the treatment of esophageal movement disorders, but large sample, multi-center, long-term study reports are needed, and it promotes the development of NOTES technology.

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“…As descriptions of GERD symptoms following any type of achalasia treatment are absolutely unreliable [39], the most reliable data are those obtained by pH monitoring. Based on several series reporting objectively determined reflux, the incidence of post-POEM GERD is between 30% and 40% [40]. The incidence of patients whose GERD symptoms cannot be controlled medically and require antireflux surgery is very low.…”

Section: Treatmentsmentioning

confidence: 99%

Achalasia: treatment, current status and future advances

Swanström

2019

Korean J Intern Med

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Achalasia was first described in the 17th century and its treatment continues to be challenging. Palliative treatment involves disruption of the lower esophageal sphincter, which can be accomplished mechanically (balloon dilation or surgical myotomy) or chemically (Botox). True surgical treatment originated some 100 years ago and remained largely unchanged until the advent of thoracoscopic and then laparoscopic myotomy beginning in the 1980s. Because these procedures provided relatively definitive treatment and were well tolerated by patients, minimal invasive surgery assumed a primary role in the treatment algorithms for achalasia. In 2008, an endoscopic (incision-less) myotomy approach, per-oral endoscopic myotomy, was described. This even less invasive approach has rapidly been adopted in the majority of high-volume achalasia centers. Newer interventions, such as stenting and cell transplant, are under active investigation.

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Peroral endoscopic myotomy leads to higher rates of abnormal esophageal acid exposure than laparoscopic Heller myotomy in achalasia

Cited by 58 publications

References 17 publications

Antireflux Surgery for Gastroesophageal Reflux Refractory to Medical Treatment After Peroral Endoscopic Myotomy

Antireflux Surgery for Gastroesophageal Reflux Refractory to Medical Treatment After Peroral Endoscopic Myotomy

Peroral endoscopic myotomy for esophageal motility disorders

Achalasia: treatment, current status and future advances

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