LONG – TERM RESULTS OF PERORAL ENDOSCOPIC MYOTOMY (POEM) FOR ACHALASIA

Aims:

POEM has gained trust by proved safety and short-term efficacy and it is considered to be a standard method for treatment of achalasia. The aim of this prospective single-center case series was to assess the long-term clinical outcome of POEM with emphasis on post-POEM reflux evaluated by pH monitoring, endoscopy findings, reflux symptoms and use of PPIs.

Methods:

Since 2012, a total of 223 patients with achalasia underwent 233 POEM procedures. Follow-up visits at 3, 12, 24 and 36 M were completed in 194, 144, 80 and 44 patients. UGI endoscopy, HRM and 24-hour pH monitoring were performed 3 M after POEM; endoscopy was then repeated between 24 – 36 M. Main outcomes were treatment success defined as Eckardt score < 3, recurrence rate and post-POEM reflux.

Results:

At 3, 12, 24 and 36 months, treatment success was achieved in 97% (CI 95%; 95 – 100), 99% (97 – 100), 94% (88 – 100) and 93% (86 – 100) of patients. A total of 15 patients experienced treatment failure (n = 5) or recurrence (n = 10). The recurrences occurred most often in patients with HRM type I achalasia (4 out of 35, 11.4%) followed by type II (5 out of 144, 3,5%) vs. none in type III (0 out of 21, 0%).

At 3 months, reflux esophagitis was diagnosed in 68/194 patients, abnormal acid exposure on pH-metry was detected in 68/194 (39.7%). At 24 – 36 M, endoscopy reflux esophagitis was present in 15/51 patients. A PPI was administered to 37% and 38% of patients at 3 and 24 M.

Conclusions:

POEM is effective treatment modality for achalasia with treatment success around 90% at 24 M, slightly dropping down to 81% at 36 M. Generally mild RE and abnormal acid exposure are diagnosed in almost 40% of patients 3 M after POEM and are successfully manageable with PPI. Occurrence of reflux esophagitis tends to decrease with time which might be a consequence of antisecretory treatment.