title: Peroral endoscopic myotomy (POEM) is safe and effective in the setting of prior endoscopic intervention.
abstract: OBJECTIVE
  We aimed to determine the safety and feasibility of peroral endoscopic myotomy (POEM) in the setting of prior endoscopic interventions.
  
  
  METHODS
  This study involves 40 consecutive patients undergoing POEM.
  
  
  METHODS
  POEM was performed for esophageal motility disorders, including achalasia, nutcracker with nonrelaxing lower esophageal sphincter (LES), hypertensive lower esophageal sphincter, and diffuse esophageal spasm.
  
  
  METHODS
  Outcome measures include length of procedure (LOP), intraoperative complications, and dysphagia relief.
  
  
  RESULTS
  Forty patients, with a mean age of 54 ± 19 years, underwent POEM. The pre-POEM intervention group consisted of 12 patients (nine achalasia, two nutcracker with nonrelaxing LES, and one diffuse esophageal spasm) who also had previous endoscopic treatment, while the pre-POEM non-intervention group consisted of 28 patients (22 achalasia, 3 hypertensive LES, 2 nutcracker with nonrelaxing LES, and 1 diffuse esophageal spasm). Ten patients had botox injections and two patients had large caliber balloon dilations prior to POEM. The median preoperative Eckardt score was 5 in the pre-POEM intervention group vs 6 in the pre-POEM non-intervention group (p value = 0.4). There was no statistical difference in the mean LOP (134 ± 43 vs 131 ± 41, p = 0.8) or the incidence of intraoperative complications (17 vs 3 %, p = 0.2) between the two groups. There was also no difference in the 6-month postoperative median Eckardt scores between the two groups (1 vs 1, p = 0.4).
  
  
  CONCLUSIONS
  POEM is safe and effective even following preoperative endoscopic large caliber balloon dilations or botox injection. These interventions do not seem to contribute to increased adverse intraoperative or postoperative clinical outcomes.
authors.affiliation: GI/MIS Division, The Oregon Clinic, Portland, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Sharata
authors.forename: Ashwin A
authors.initials: AA
authors.lastname: Kurian
authors.forename: Christy M
authors.initials: CM
authors.lastname: Dunst
authors.forename: Neil H
authors.initials: NH
authors.lastname: Bhayani
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Reavis
authors.forename: Lee L
authors.initials: LL
authors.lastname: Swanström
mesh_terms: D019274:Botulinum Toxins, Type A; D004106:Dilatation; D015154:Esophageal Motility Disorders / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery; D012189:Retrospective Studies
chemical_list: D019274:Botulinum Toxins, Type A