title: Peroral endoscopic myotomy is a viable option for failed surgical esophagocardiomyotomy instead of redo surgical Heller myotomy: a single center prospective study.
abstract: BACKGROUND
  Surgical Heller myotomy has high rates of successful long-term results, but failed cases still remain. Moreover, the treatment strategy in patients with surgical myotomy failure is controversial. Recently, peroral endscopic myotomy (POEM) was reported to be efficient and safe in primary treatment of achalasia. In this study, we aimed to evaluate the efficacy and safety of POEM for surgical myotomy failure as a rescue second-line treatment, and we discuss the treatment options adapted in achalasia recurrence.
  
  
  METHODS
  A total of 315 consecutive achalasia patients received POEM from September 2008 to December 2012 in our hospital. Eleven (3.5%) patients who had persistent or recurrent achalasia and had received surgical myotomy as a first-line treatment from other hospitals were included in this study. Patient background, barium swallow studies, esophagogastroduodenoscopy (EGD), manometry, and symptom scores were prospectively evaluated. In principle, all patients in whom surgical myotomy failed received pneumatic balloon dilatation (PBD) as the first line "rescue" treatment, and only if PBD failed were patients considered for rescue POEM.
  
  
  RESULTS
  The PBD alone was effective in 1 patient, and in the remaining 10 patients, rescue POEM was performed successfully without complications. Three months after rescue POEM, significant reduction in lower esophageal sphincter (LES) resting pressures (22.1 ± 6.6 mmHg vs 10.9 ± 4.5 mmHg, p < 0.01) and Eckardt symptom scores (6.5 ± 1.3 vs 1.1 ± 1.3, p < 0.001) were observed.
  
  
  CONCLUSIONS
  Short-term results of POEM for failed surgical myotomy were excellent. Long-term results are awaited.
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan. Electronic address: mnbonmr0827@gmail.com.
authors.forename: Manabu
authors.initials: M
authors.lastname: Onimaru
authors.forename: Haruhiro
authors.initials: H
authors.lastname: Inoue
authors.forename: Haruo
authors.initials: H
authors.lastname: Ikeda
authors.forename: Akira
authors.initials: A
authors.lastname: Yoshida
authors.forename: Esperanza Grace
authors.initials: EG
authors.lastname: Santi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sato
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ito
authors.forename: Roberta
authors.initials: R
authors.lastname: Maselli
authors.forename: Shin-ei
authors.initials: SE
authors.lastname: Kudo
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization; D004106:Dilatation; D004724:Endoscopy; D004931:Esophageal Achalasia / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D017211:Treatment Failure
keywords: EGD; GEJ; GER; LES; NS; PBD; POEM; Sig; esophagogastroduodenoscopy; gastroesophageal junction; gastroesophageal reflux; lower esophageal sphincter; nonsigmoid type; peroral endoscopic myotomy; pneumatic balloon dilatation; sigmoid type