Management of recurrent symptoms after per-oral endoscopic myotomy in achalasia

Froukje B. van Hoeij, Fraukje A. Ponds, Yuki Werner, Joel M. Sternbach, Paul Fockens, Barbara A. Bastiaansen, André J. P. M. Smout, John E. Pandolfino, Thomas Rösch, Albert J. Bredenoord

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Abstract

Background and Aims Per-oral endoscopic myotomy (POEM) has been rapidly gaining ground as a treatment for achalasia. Although POEM is a safe and effective treatment, a subset of patients has persistent or recurrent symptoms after POEM. This study aimed to examine the efficacy of different retreatments after failed POEM. Methods POEM was performed on 441 patients with achalasia at 3 tertiary-care hospitals between 2010 and 2015. A review of prospectively collected data was conducted. All patients with achalasia with significant persistent or recurrent symptoms within 3 years after POEM, defined as an Eckardt symptom score >3, were included. Results Forty-three of 441 patients (9.8%) had persistent or recurrent symptoms after POEM, of which 34 (8%) received 1 or more retreatments. Retreatment with laparoscopic Heller myotomy and retreatment with POEM showed a modest efficacy of 45% and 63%, respectively, whereas pneumatic dilatation showed a poor efficacy of only 0% to 20%, depending on the size of the balloon. Male patients were more likely to have retreatment failure than female patients (P =.038). Conclusions In patients with achalasia with persistent or recurrent symptoms after failed POEM, retreatment with laparoscopic Heller myotomy or retreatment with POEM has a higher efficacy than retreatment with pneumatic dilatations. Failure of retreatment occurred more often in male patients.
Original languageEnglish
Pages (from-to)95-101
JournalGastrointestinal Endoscopy
Volume87
Issue number1
DOIs
Publication statusPublished - 2018
Externally publishedYes

Cite this

van Hoeij, F. B., Ponds, F. A., Werner, Y., Sternbach, J. M., Fockens, P., Bastiaansen, B. A., ... Bredenoord, A. J. (2018). Management of recurrent symptoms after per-oral endoscopic myotomy in achalasia. Gastrointestinal Endoscopy, 87(1), 95-101. https://doi.org/10.1016/j.gie.2017.04.036