Does Prior Treatment Impact Outcomes of POEM in Patients With Achalasia?

Does Prior Treatment Impact Outcomes of POEM in Patients With Achalasia?

Prateek Sharma, MD, FASGE reviewing Liu ZQ, et al. Endoscopy 2019 Apr.

The major treatment options for achalasia include laparoscopic Heller myotomy, pneumatic balloon dilation, or peroral endoscopic myotomy (POEM). With the increasing utilization of POEM, it is also used in patients who have failed some of these treatment options. 

In this retrospective, single-center study, 849 patients who completed follow-up after a POEM and had an Eckardt score ≥4 were identified and defined as a clinical failure. Outcomes within this patient population, including perioperative major adverse events, clinical GERD development, and failure during follow-up, were assessed and compared between those with and without prior treatment. Overall, 245 patients (28.9%) had undergone prior treatment: dilation (n=165), botulinum toxin injection (n=46), esophageal stent placement (n=45), Heller myotomy (n=28), and POEM (n=6); and 34 patients (4%) experienced a major adverse event associated with the POEM procedure. During a median follow-up of 23 months, GERD and clinical failure were reported in 24% and 1% of the patients, respectively. Patients with prior treatment had a longer procedure duration (P=0.001), longer hospital stay (P=0.001), and increased clinical failure during follow-up (hazard ratio, 1.90; P=0.002). However, prior treatment was not an independent risk factor for major adverse events (odds ratio [OR], 1.19; P=0.65) or GERD (OR, 1.26; P=0.19).

COMMENT

In achalasia patients who have previously failed endoscopic or surgical treatment, POEM can be safely performed, with a low rate of major adverse events. However, compared to patients without previous treatment, POEM is associated with a longer procedure duration and hospital stay and a higher rate of clinical failure in this patient population.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Prateek Sharma, MD, FASGE

CITATION(S)

Liu ZQ, Li QL, Chen WF, et al. The effect of prior treatment on clinical outcomes in patients with achalasia undergoing peroral endoscopic myotomy. Endoscopy 2019;51:307-316. (https://doi.org/10.1055/a-0658-5783)

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