The Efficacy of Peroral Endoscopic Myotomy vs Pneumatic Dilation as Treatment for Patients With Achalasia Suffering From Persistent or Recurrent Symptoms After Laparoscopic Heller Myotomy: A Randomized Clinical Trial

Saleh, Caroline M.G.; Familiari, Pietro; Bastiaansen, Barbara A.; Fockens, Paul; Tack, Jan; Boeckxstaens, Guy E.; Bisschops, Raf; Lei, Aaltje; Schijven, Marlies P.; Costamagna, Jan Guido; Bredenoord, Albert J.

doi:10.1053/j.gastro.2023.02.048

Cited by 19 publications

(7 citation statements)

References 33 publications

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“…Prior studies with short‐term follow‐up reveal a clinical success rate spanning from 62% to 96% in patients with prior HM (Table 4). On the other hand, clinical efficacy of pneumatic dilatation in this setting, according to two recent studies, was 26% and 57%, respectively 17,18 . The findings of our study, in addition to the published evidence, suggest that POEM should be preferred to pneumatic dilatation in cases who relapse or continue to have symptoms after HM.…”

Section: Discussionsupporting

confidence: 65%

“…The response to pneumatic dilatation is often sub‐optimal in cases with persistent or recurrent symptoms after HM 17 . Recent studies, however, suggest that POEM may be an effective treatment option in these instances 10,12,18–20 . In the absence of long‐term data, the durability of response after POEM in cases with failed HM remains ambiguous.…”

Section: Discussionmentioning

confidence: 99%

“…17 Recent studies, however, suggest that POEM may be an effective treatment option in these instances. 10,12,[18][19][20] In the absence of long-term data, the durability of response after POEM in cases with failed HM remains ambiguous. In this study, we examined the durability of the response to POEM in patients with persistent or recurrent symptoms following HM.…”

Section: Discussionmentioning

confidence: 99%

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Per‐oral endoscopic myotomy in cases with prior Heller's myotomy: Outcomes at a median follow‐up of 5 years

Nabi,

Ramchandani,

Basha

et al. 2023

J of Gastro and Hepatol

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Background and AimPer‐oral endoscopic myotomy (POEM) is an established treatment for achalasia cardia. However, data on the long‐term efficacy of POEM in patients with failed Heller's myotomy (HM) are limited. The purpose of this study was to evaluate the long‐term outcomes of POEM in patients with persistent or recurrent symptoms following HM.MethodsData of patients with recurrence of symptoms after HM who underwent POEM (September 2013 to December 2022) were analyzed, retrospectively. Primary outcome was clinical success [Eckardt score (ES) ≤ 3]. Secondary outcomes included improvement of manometry parameters, barium emptying at 5 min and gastroesophageal reflux (esophagitis and increased esophageal acid exposure) after POEM.ResultsSeventy‐two cases (45.9 ± 13.4 years, 43 men) with history of HM were included in the study. The subtypes of achalasia were type 1 (40.3%), type 2 (37.5%), and unknown (19.4%). Prior treatment included HM in 48 (66.7%), HM plus pneumatic dilatation in 20 (27.8%), and HM plus pneumatic dilatation and Botox in 4 (5.5%). Technical success was achieved in all cases. Mean length of myotomy was 10.7 ± 3.3 cm, and mean procedure duration was 59.2 ± 25.9 min. There was significant improvement in ES (pre‐POEM 6.5 ± 1.8 vs post‐POEM 0.7 ± 0.7), lower esophageal sphincter pressure pressures (31.7 ± 12.5 vs 13.3 ± 5.7 mmHg) and barium emptying (14.2 ± 4.2 vs 2.4 ± 3.1 cm) after POEM. At a median follow‐up of 63 months (IQR 40–95), clinical success (ES ≤ 3) was documented in 58 (80.6%) patients. Reflux esophagitis and increased esophageal acid exposure were recorded in 28 of 49 (57.1%) and 11 of 20 (55%) patients, respectively.ConclusionPOEM is a durable treatment modality in cases with relapse of symptoms after HM.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Per‐oral endoscopic myotomy in cases with prior Heller's myotomy: Outcomes at a median follow‐up of 5 years

Nabi,

Ramchandani,

Basha

et al. 2023

J of Gastro and Hepatol

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“…More than one thousand institutions worldwide were engaged in the study of POEM in treating achalasia. Among them, the top ten by the number of publications were Showa Univer-sity (69), Northwestern University (44), Asian Institute of Gastroenterology (37), Fudan University (33), University of Chicago (25), Kobe University Hospital (22), Johns Hopkins Medical Institution (21), Niigata University (20), Fukuoka University (20), and Oregon Clinic (20) (Figure 4A). In the top 10 institutions, Japan and the USA each had four organizations, while India and China each had one organization.…”

Section: Institution Analysismentioning

confidence: 99%

A bibliometric analysis of peroral endoscopic myotomy for achalasia: Where have we been and where should we go next?

Zhang

2023

Japanese J Gastroenterol Res

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“…In case of recurrent dysphagia after LHM, pneumatic dilatation can alleviate the symptoms in most patients [24]. Alternatively, POEM can be used, as it avoids a challenging redo operation because of the presence of adhesions and scar tissue and can be done safely on the posterior wall of the esophagus with very good results [25,26 ▪ ]. An esophagectomy should be considered a last resort, only after the failure of all the other treatment modalities.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic heller myotomy versus peroral endoscopic myotomy for the treatment of achalasia

Patti,

Herbella

2024

Current Opinion in Gastroenterology

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Purpose of review To compare different therapeutic modalities and determine their role in the treatment of esophageal achalasia. Recent findings The last 3 decades have seen a significant improvement in the diagnosis and treatment of esophageal achalasia. Conventional manometry has been replaced by high-resolution manometry, which has determined a more precise classification of achalasia in three subtypes, with important treatment implications. Therapy, while still palliative, has evolved tremendously. While pneumatic dilatation was for a long time the main choice of treatment, this approach slowly changed at the beginning of the nineties when minimally invasive surgery was adopted, initially thoracoscopically and then laparoscopically with the addition of partial fundoplication. And in 2010, the first report of a new endoscopic technique – peroral endoscopic myotomy (POEM) – was published, revamping the interest in the endoscopic treatment of achalasia. Summary This review focuses particularly on the comparison of POEM and laparoscopic Heller myotomy (LHM) with partial fundoplication as primary treatment modality for esophageal achalasia. Based on the available data, we believe that LHM with partial fundoplication should be the primary treatment modality in most patients. POEM should be selected when surgical expertise is not available, for type III achalasia, for the treatment of recurrent symptoms, and for patients who had prior abdominal operations that would make LHM challenging and unsafe.

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The Efficacy of Peroral Endoscopic Myotomy vs Pneumatic Dilation as Treatment for Patients With Achalasia Suffering From Persistent or Recurrent Symptoms After Laparoscopic Heller Myotomy: A Randomized Clinical Trial

Cited by 19 publications

References 33 publications

Per‐oral endoscopic myotomy in cases with prior Heller's myotomy: Outcomes at a median follow‐up of 5 years

Per‐oral endoscopic myotomy in cases with prior Heller's myotomy: Outcomes at a median follow‐up of 5 years

A bibliometric analysis of peroral endoscopic myotomy for achalasia: Where have we been and where should we go next?

Laparoscopic heller myotomy versus peroral endoscopic myotomy for the treatment of achalasia

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