Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study
Olaya I. Brewer Gutierrez, Robert A. Moran, Pietro Familiari, Mohamad Dbouk, Guido Costamagna, Yervant Ichkhanian, Stefan Seewald, Amol Bapaye, Joo Young Cho, Maximilien Barret, Nikolas Eleftheriadis, Mathieu Pioche, Bu Hayee, Marcel Tanțău, Michael Ujiki, Rosario Landi, Martina Invernizzi, In Kyung Yoo, Sabine Roman, Amyn Haji, H. Mason Hedberg, Nasim Parsa, François Mion, Lea Fayad, Vivek Kumbhari, Anant Agarwalla, Saowanee Ngamruengphong, Omid Sanaei, Thierry Ponchon, Mouen A. Khashab
Abstract
Abstract 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.