title: Peroral endoscopic myotomy (POEM): feasible as reoperation following Heller myotomy.
abstract: OBJECTIVE
  The purpose of this study was to demonstrate the feasibility of performing peroral endoscopic myotomy (POEM) in the management of recurrent achalasia after failed myotomy.
  
  
  METHODS
  Eight patients presented to our institution between October 2010 and June 2013 with recurrent/persistent symptoms after prior laparoscopic Heller myotomy. Three patients underwent redo laparoscopic Heller myotomy, and five patients consented to redo myotomy with POEM.
  
  
  RESULTS
  Demographics were similar between the groups with exception of age (POEM 69.5 vs. laparoscopic Heller myotomy (LHM) 34.5, p = 0.003). Preoperative Eckardt scores, motility, and prior interventions were not significantly different. Three patients who underwent POEM and two who underwent laparoscopic Heller myotomy had prior fundoplication. There was one perforation identified after laparoscopic Heller myotomy and one patient with persistent subcutaneous emphysema after POEM. Both POEM and laparoscopic Heller myotomy demonstrated significant improvement in symptoms and Eckardt scores at average follow-up of approximately 5 months (p < 0.05).
  
  
  CONCLUSIONS
  POEM is a feasible option for patients after failed myotomy even in the presence of prior fundoplication. The procedure can be performed safely using a similar technique as for primary myotomy with the exception of creating the myotomy laterally along the right side of the esophagus and lesser curvature avoiding the previous anterior myotomy.
authors.forename: Yalini
authors.initials: Y
authors.lastname: Vigneswaran
authors.forename: Amy K
authors.initials: AK
authors.lastname: Yetasook
authors.forename: Jin-Cheng
authors.initials: JC
authors.lastname: Zhao
authors.forename: Woody
authors.initials: W
authors.lastname: Denham
authors.forename: John G
authors.initials: JG
authors.lastname: Linn
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ujiki
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D004945:Esophagoscopy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009092:Mucous Membrane / Q000601:surgery; D061646:Operative Time; D012008:Recurrence; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D012720:Severity of Illness Index