title: A prospective analysis of GERD after POEM on anterior myotomy.
abstract: Peroral endoscopic myotomy (POEM) is an emerging, minimally invasive procedure capable of overcoming limitations of achalasia treatments, but gastroesophageal reflux disease (GERD) after POEM is of concern and its risk factors have not been evaluated. This prospective study examined GERD and the association of POEM with reflux esophagitis.
  
  
  
  Achalasia patients were recruited from a single center. The pre- and postoperative assessments included Eckardt scores, manometry, endoscopy, and pH monitoring.
  
  
  
  Between September 2011 and November 2014, 105 patients underwent POEM; 70 patients were followed up 3 months after POEM. Postoperatively, significant reductions were observed in lower esophageal sphincter (LES) pressure [from 40.0 ± 22.8 to 20.7 ± 14.0 mmHg (P < 0.05)], LES residual pressure [from 22.1 ± 13.3 to 11.4 ± 6.6 mmHg (P < 0.05)], and Eckardt scores [from 5.7 ± 2.5 to 0.7 ± 0.8 (P < 0.05)]. Symptomatic GERD and moderate reflux esophagitis developed in 5 and 11 patients (grade B, n = 8; grade C, n = 3), respectively, and were well controlled with proton pump inhibitors. Univariate logistic regression analysis revealed integrated relaxation pressure was a predictor of ≥grade B reflux esophagitis. No POEM factors were found to be associated with reflux esophagitis.
  
  
  
  POEM is effective and safe in treating achalasia, with no occurrence of clinically significant refractory GERD. Myotomy during POEM, especially of the gastric side, was not associated with ≥grade B (requiring medical intervention) reflux esophagitis. Extended gastric myotomy (2-3 cm) during POEM is recommended to improve outcomes.
authors.affiliation: Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. hiro.shiwaku@gmail.com.
authors.forename: Hironari
authors.initials: H
authors.lastname: Shiwaku
authors.affiliation: Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
authors.forename: Haruhiro
authors.initials: H
authors.lastname: Inoue
authors.affiliation: Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Sasaki
authors.affiliation: Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Kanefumi
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Ohmiya
authors.affiliation: Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Takeno
authors.affiliation: Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nimura
authors.affiliation: Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yamashita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004931:Esophageal Achalasia / Q000601:surgery*; D004942:Esophagitis, Peptic / Q000209:etiology; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000209:etiology*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009126:Muscle Relaxation / Q000502:physiology; D009130:Muscle, Smooth / Q000503:physiopathology; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects* / Q000379:methods; D011312:Pressure; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Achalasia; GERD; POEM