title: Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for treatment of achalasia.
abstract: BACKGROUND
  Peroral esophageal myotomy (POEM) is a new endoscopic operation for the treatment of achalasia. Here, we report 1-year physiologic and symptomatic outcomes following the procedure.
  
  
  METHODS
  POEM patients from a single-institution series who were more than 1 year removed from surgery were studied. Eckardt and GerdQ scores were obtained to assess symptoms. High-resolution manometry (HRM), timed barium esophagram (TBE), and upper endoscopy were preformed preoperatively and at 1-year follow-up. 24-h pH monitoring was also performed at 1 year follow-up.
  
  
  RESULTS
  The study population was comprised of 41 patients who were more than 1 year post-POEM. One (2%) major complication, a contained leak at the EGJ requiring re-operation, and 7 (17%) minor complications occurred. Mean length of stay was 1.4 days. At mean 15-month follow-up, Eckardt scores improved from pre-POEM 7 ± 2 to post-POEM 1 ± 2, (scale 0-12, p < .001), and 92% of patients achieved treatment success (Eckardt score <4). Two of the three treatment failures in the series occurred in the initial three patients. 15% of patients had post-POEM symptoms suggestive of gastroesophageal reflux (GerdQ >7). On follow-up HRM, esophagogastric junction integrated relaxation pressure was decreased significantly (pre-POEM 28 ± 12 mmHg vs. post-POEM 11 ± 4 mmHg, p < .001), and 47% of patients studied had partial recovery of peristalsis. On follow-up TBE, barium column heights were decreased compared with preoperatively. Postoperative upper endoscopy revealed esophagitis in 59% of patients (11 LA Grade A, 2 LA Grade D). However, of the 13 24-h pH monitoring studies performed, only four (31%) demonstrated pathologic esophageal acid exposure.
  
  
  CONCLUSIONS
  In this series, POEM resulted in greater than 90% symptomatic treatment success at mean 15-month follow-up. Rates of iatrogenic gastroesophageal reflux, as measured both by symptoms and 24-h pH monitoring, appeared to be on par with recent studies of patients undergoing laparoscopic Heller myotomy and pneumatic dilation.
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Chicago, IL, 60611, USA, ezratei@gmail.com.
authors.forename: Ezra N
authors.initials: EN
authors.lastname: Teitelbaum
authors.forename: Nathaniel J
authors.initials: NJ
authors.lastname: Soper
authors.forename: Byron F
authors.initials: BF
authors.lastname: Santos
authors.forename: Fahd O
authors.initials: FO
authors.lastname: Arafat
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kahrilas
authors.forename: Ikuo
authors.initials: I
authors.lastname: Hirano
authors.forename: Eric S
authors.initials: ES
authors.lastname: Hungness
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008365:Manometry; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome; D055815:Young Adult