LONG-TERM EFFICACY AND GASTROESOPHAGEAL REFLUX DISEASE AFTER PER ORAL ENDOSCOPIC MYOTOMY (POEM): A PROSPECTIVE STUDY WITH 5-YEARS OBJECTIVE FOLLOW-UP

Aims Peroral endoscopic myotomy (POEM) has shown excellent short-term safety and efficacy; long-term data are limited. Aim of the study was to assess durability of POEM efficacy and long-term GERD evolution.

Methods We prospectively included all patients who underwent POEM between June 2012 and August 2016 at our center. At 3, 12, 36 and 60 months after POEM, patients underwent clinical assessment and objective follow-up with high-resolution manometry, upper endoscopy and pH-impedance study.

Results Out of 414 consecutive patients treated (2012-2021), 94 had long term follow-up and were included. Median age was 57 years (range 17-90), 65.9% were males; 68.1% had achalasia type II. Adverse events occurred in 9.5% of patients: 5 mild and 4 moderate. No severe adverse events, surgical conversions or deaths occurred.

Clinical success after POEM persisted in 95.7%, 93.3%, 86.49% and 84.51% of patients at 3, 12, 36 and 60 months; respective clinical reflux rates were 28.7%, 38.6%, 35,7% and 20.9%; a significant decrease was observed between 12 and 60 months (38.6% vs 20.9%, p=0.02).

As regards objective GERD monitoring, low grade erosive esophagitis (Los Angeles A-B) was observed in 29.5%, 22.7%, 40% and 31.7%, grade C-D in 1.1%, 2.5%, 3.6% and 2.4% at 3, 12, 36 and 60 months; respective abnormal pH-impedance study rates were 31.5%, 28.3%, 30.4% and 26.4%.

Conclusions POEM shows reassuring long-term efficacy and safety, with clinical success persisting in more than 80% of patients after 5 years. Clinical post-POEM reflux affects nearly 1 out of 4 patients and seems to decrease over time.

Publication History

Article published online:
14 April 2022