Aims Laparoscopic fundoplication (LF) is the gold standard treatment of refractory gastro-esophageal
reflux (GERD). However, it may induce dysphagia in 5 to 10% of the cases. LF could
induce de novo esophageal motility disorder (EMD) in 20% of the patients, inducing
severe dysphagia and impaired quality of life. The management is difficult since 15%
require surgical revision. Our objectives were to evaluate the efficacy of POEM on
dysphagia, and to document the technical particularities and the complications
Methods Retrospective report of consecutive patients treated by POEM for dysphagia associated
to EMD after LF. All patients had normal a high-resolution manometry (HRM) before
the surgery. All were suffering from severe and persistent dysphagia, refusing revisional
surgery, with abnormal findings at HRM. The procedure was a regular esophageal POEM,
including a cardial deep myotomy. The clinical assessment included Eckardt and dysphagia
score and weight
Results Eight patients (5 men, 3 women; median age: 67.5 [44-81] years old) were included.
The surgery was a Nissen LF in 4 patients and a Toupet LF in 4 patients. HRM showed
aperistaltism in 6/8 patients, and an impaired LES relaxations in 6 others, four having
both disorders. 4 patients underwent previous endoscopic pneumatic dilation. The median
Eckardt and Dysphagia scores were 5/12 [8-11] and 3.5/5[2-4], respectively.
The procedure was completed in 7/8 patients (one complete fibrosis), without complication.
The submucosa appeared more fibrotic and vascularized, slightly lengthening the time.
The clinical efficacy rate was 75% (6/8). The median post-operative Eckardt and Dysphagia
scores were 1.5/12 [0-9] et 0,5/5 [0-3], respectively, after a median follow-up of
13 months [4-53]. One failure was the technical failure, the other had two pneumatic
dilations finally effective.
Conclusions POEM is an interesting and safe option to manage disabling dysphagia associated with
EMD after LF, and deserves larger evaluation to confirm these promising outcomes.
