Background and study aims The aim of this study was to assess long-term clinical outcomes beyond 6 years in patients who underwent per-oral endoscopic myotomy (POEM) for the treatment of achalasia.Patients and methods Patients with achalasia who underwent POEM between 2010 and 2012 and had follow-up of at least 6 years were retrospectively identified at eight tertiary care centers. The primary outcome evaluated was clinical success defined by an Eckardt symptom score (ESS) <= 3 for the duration of the follow-up period. The clinical success cohort was compared to failure (ESS >3 at any time during follow-up) in order to identify characteristics associated with symptom relapse. The incidence of patient-reported gastroesophageal reflux (GER) was also evaluated.Results Seventy-three patients with 6-year follow-up data were identified. Sustained clinical remission was noted in 89% (65/73) at 6-years. Mean ESS decreased from 7.1 +/- 2.3 pre-procedure to 1.1 +/- 1.1 at 6 years (P<0.001). Symptomatic reflux was reported by 27 of 72 patients (37.5%). Type I achalasia (OR 10.8, P=0.04) was found to be associated with clinical failure on logistic regression analysis.Conclusions In patients with achalasia, POEM provides high initial clinical success with excellent long-term outcomes. There are high rates of patient-reported gastro-esophageal reflux post-procedure which persist at long-term follow-up.
Abimansour, J. P., Ichkhanian, Y., Minami, H., Familiari, P., Landi, R., Costamagna, G., Seewald, S., Callahan, Z. M., Ujiki, M. B., Pioche, M., Ponchon, T., Roman, S., Cho, J. Y., Yoo, I. K., Sippey, M., Marks, J. M., Eleftheriadis, N., Khumbari, V., Gutierrez, O. I. B., Khashab, M. A., Durability of per-oral endoscopic myotomy beyond 6 years, <<ENDOSCOPY INTERNATIONAL OPEN>>, 2021; 9 (11): E1595-E1601. [doi:10.1055/a-1553-9846] [https://hdl.handle.net/10807/229454]
Durability of per-oral endoscopic myotomy beyond 6 years
Familiari, Pietro;Landi, Rosario;Costamagna, Guido;
2021
Abstract
Background and study aims The aim of this study was to assess long-term clinical outcomes beyond 6 years in patients who underwent per-oral endoscopic myotomy (POEM) for the treatment of achalasia.Patients and methods Patients with achalasia who underwent POEM between 2010 and 2012 and had follow-up of at least 6 years were retrospectively identified at eight tertiary care centers. The primary outcome evaluated was clinical success defined by an Eckardt symptom score (ESS) <= 3 for the duration of the follow-up period. The clinical success cohort was compared to failure (ESS >3 at any time during follow-up) in order to identify characteristics associated with symptom relapse. The incidence of patient-reported gastroesophageal reflux (GER) was also evaluated.Results Seventy-three patients with 6-year follow-up data were identified. Sustained clinical remission was noted in 89% (65/73) at 6-years. Mean ESS decreased from 7.1 +/- 2.3 pre-procedure to 1.1 +/- 1.1 at 6 years (P<0.001). Symptomatic reflux was reported by 27 of 72 patients (37.5%). Type I achalasia (OR 10.8, P=0.04) was found to be associated with clinical failure on logistic regression analysis.Conclusions In patients with achalasia, POEM provides high initial clinical success with excellent long-term outcomes. There are high rates of patient-reported gastro-esophageal reflux post-procedure which persist at long-term follow-up.
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