Endoscopy 2021; 53(10): 1003-1010
DOI: 10.1055/a-1312-0496
Original article

Management of patients after failed peroral endoscopic myotomy: a multicenter study

Yervant Ichkhanian*
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
,
Daniella Assis*
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
,
Pietro Familiari
 2  Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Michael Ujiki
 3  Department of Surgery, Northshore University Health System, Chicago, Illinois, USA
,
Baily Su
 4  Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
,
Sarah R. Khan
 5  Department of Medicine, Saint Agnes Hospital, Baltimore, Maryland, USA
,
Mathieu Pioche
 6  Department of Endoscopy and Gastroenterology, Pavillon L Edouard Herriot Hospital, Lyon, France
,
Peter V. Draganov
 7  University of Florida, Gainesville, Florida, USA
,
Joo young Cho
 8  CHA Bundang Medical Center, Seongnam, Republic of Korea
,
Nikolas Eleftheriadis
 9  Euromedica Kyanous Stauros, Thessaloniki, Greece
,
10  Cochin Hospital, Paris, France
,
Amyn Haji
11  King's College NHS Foundation Trust, London, UK
,
Vic Velanovich
12  University of South Florida, Tampa, Florida, USA
,
Marcel Tantau
13  Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
,
Jeffrey M. Marks
14  University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
,
15  Deenanath Mangeshkar Hospital, Pune, India
,
Alireza Sedarat
16  UCLA School of Medicine, Los Angeles, California, USA
,
17  Gastroenterology Department, Complejo Hospitalario de Navarra, Navarro, Spain
,
18  Queen's University, Kingston, Ontario, Canada
,
Nikhil A. Kumta
19  Icahn School of Medicine at Mount Sinai, New York, New York, USA
,
 2  Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Yaseen B. Perbtani
 7  University of Florida, Gainesville, Florida, USA
,
Mehul Patel
11  King's College NHS Foundation Trust, London, UK
,
Megan Sippey
14  University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
,
Sravan K. Korrapati
15  Deenanath Mangeshkar Hospital, Pune, India
,
Rishabh Jain
15  Deenanath Mangeshkar Hospital, Pune, India
,
Fermín Estremera
17  Gastroenterology Department, Complejo Hospitalario de Navarra, Navarro, Spain
,
Mohamad H. El Zein
20  Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, USA
,
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
,
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
› Author Affiliations

Abstract

Background Although peroral endoscopic myotomy (POEM) is highly effective for the management of achalasia, clinical failures may occur. The optimal management of patients who fail POEM is not well known. This study aimed to compare the outcomes of different management strategies in patients who had failed POEM.

Methods This was an international multicenter retrospective study at 16 tertiary centers between January 2012 and November 2019. All patients who underwent POEM and experienced persistent or recurrent symptoms (Eckardt score > 3) were included. The primary outcome was to compare the rates of clinical success (Eckardt score ≤ 3) between different management strategies.

Results 99 patients (50 men [50.5 %]; mean age 51.4 [standard deviation (SD) 16.2]) experienced clinical failure during the study period, with a mean (SD) Eckardt score of 5.4 (0.3). A total of 29 patients (32.2 %) were managed conservatively and 70 (71 %) underwent retreatment (repeat POEM 33 [33 %], pneumatic dilation 30 [30 %], and laparoscopic Heller myotomy (LHM) 7 [7.1 %]). During a median follow-up of 10 (interquartile range 3 – 20) months, clinical success was highest in patients who underwent repeat POEM (25 /33 [76 %]; mean [SD] Eckardt score 2.1 [2.1]), followed by pneumatic dilation (18/30 [60 %]; Eckardt score 2.8 [2.3]), and LHM (2/7 [29 %]; Eckardt score 4 [1.8]; P = 0.12). A total of 11 patients in the conservative group (37.9 %; mean Eckardt score 4 [1.8]) achieved clinical success.

Conclusion This study comprehensively assessed an international cohort of patients who underwent management of failed POEM. Repeat POEM and pneumatic dilation achieved acceptable clinical success, with excellent safety profiles.

* Contributed equally to this article


Table e1, e2. e3



Publication History

Received: 20 June 2020

Accepted after revision: 16 November 2020

Publication Date:
16 November 2020 (online)

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