Abstract
Introduction Increased esophageal acid exposure is seen in a large percentage of patients with
achalasia who undergo peroral endoscopic myotomy (POEM). Endoscopic transoral fundoplication
(TIF) is a novel endoscopic technique for the management of patients with chronic
gastroesophageal reflux (GERD). We present the first case series evaluating the role
of TIF post-POEM.
Methods Consecutive patients 18 years or older from our academic institution who underwent
a POEM procedure and subsequently underwent TIF for symptomatic reflux or regurgitation
between December 2014 and June 2017 were included. The primary outcome was discontinuation
of proton-pump inhibitor (PPI) use and healing of esophagitis (when initially present)
on post-procedure esophagogastroduodenoscopy (EGD). Technical success was defined
as successful completion of the endoscopic fundoplication. Adverse events (AEs) were
recorded for all patients.
Results Five patients were included (60 % male, average age 55 ± 14 years). Technical success
was achieved in 100 % of patients. Discontinuation of PPI use was achieved in 5/5
patients (100 %). Three patients had esophagitis pre-procedure and all were noted
to have resolution of inflammation on post-procedure EGD. No adverse events were noted.
Mean follow-up time was 27 months (range 5 – 34 months).
Conclusion TIF post-POEM appears feasible, safe, and efficacious in improving symptoms and esophagitis,
decreasing long-term risks of acid exposure, and decreasing risks of long-term PPI
use in patients post-POEM in this small cohort of patients. Larger studies are needed
to confirm these initial findings.
