Long-term outcomes of per-oral endoscopic myotomy in patients with achalasia with a minimum follow-up of 2 years: an international multicenter study.
OBJECTIVE
Per-oral endoscopic myotomy (POEM) has shown promising safety and efficacy in short-term studies. However, long-term follow-up data are very limited. The aims of this study were to assess (1) clinical outcome of patients with a minimum post-POEM follow-up of 2 years and (2) factors associated with long-term clinical failure after POEM.


METHODS
A retrospective chart review was performed that included all consecutive patients with achalasia who underwent POEM with a minimum follow-up of 2 years at 10 tertiary-care centers. Clinical response was defined by a decrease in Eckardt score to 3 or lower.


RESULTS
A total of 205 patients (45.8% men; mean age, 49 years) were followed for a median of 31 months (interquartile range, 26-38 months). Of these, 81 patients (39.5%) had received previous treatment for achalasia before POEM. Clinical success was achieved in 98% (185/189), 98% (142/144), and 91% (187/205) of patients with follow-up within 6 months, at 12 months, and ≥24 months, respectively. Of 185 patients with clinical response at 6 months, 11 (6%) experienced recurrent symptoms at 2 years. History of previous pneumatic dilation was associated with long-term treatment failure (odds ratio, 3.41; 95% confidence interval, 1.25-9.23). Procedure-related adverse events occurred in 8.2% of patients and only 1 patient required surgical intervention. Abnormal esophageal acid exposure and reflux esophagitis were documented in 37.5% and 18% of patients, respectively. However, these rates are simply a reference number among a very selective group of patients.


CONCLUSIONS
POEM is safe and provides high initial clinical success and excellent long-term outcomes. Among patients with confirmed clinical response within 6 months, 6% had recurrent symptoms by 2 years.
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Saowanee
S
Ngamruengphong
Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
Haruhiro
H
Inoue
Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Philip Wai-Yan
PW
Chiu
Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Hon Chi
HC
Yip
Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
Amol
A
Bapaye
Department of Surgery, NorthShore University HealthSystem, Chicago, Illinois, USA.
Michael
M
Ujiki
Department of Surgery, NorthShore University HealthSystem, Chicago, Illinois, USA.
Lava
L
Patel
Surat Institute Of Digestive Sciences, Surat, India.
Pankaj N
PN
Desai
Department of Gastroenterology, Kings College Hospital NHS Foundation Trust, London, United Kingdom.
Bu
B
Hayee
Department of Gastroenterology, Kings College Hospital NHS Foundation Trust, London, United Kingdom.
Amyn
A
Haji
Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Vivien Wai-Yin
VW
Wong
Department of Gastrointestinal and Endocrine Surgery, University of Strasbourg, Strasbourg, France.
Silvana
S
Perretta
Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
Shivangi
S
Dorwat
Gastroenterology and Endoscopy Unit, Digestive Disease Department, L Pavillon-Edouard Herriot Hospital, Lyon, France.
Mathieu
M
Pioche
Université de Lyon and Hospices Civils de Lyon, Digestive Physiology, E Herriot Hospital, Lyon, France; INSERM U1032, Lyon, France.
Sabine
S
Roman
Gastroenterology and Endoscopy Unit, Digestive Disease Department, L Pavillon-Edouard Herriot Hospital, Lyon, France.
Jérôme
J
Rivory
Université de Lyon and Hospices Civils de Lyon, Digestive Physiology, E Herriot Hospital, Lyon, France; INSERM U1032, Lyon, France.
François
F
Mion
Gastroenterology and Endoscopy Unit, Digestive Disease Department, L Pavillon-Edouard Herriot Hospital, Lyon, France.
Thierry
T
Ponchon
Université de Lyon and Hospices Civils de Lyon, Digestive Physiology, E Herriot Hospital, Lyon, France; INSERM U1032, Lyon, France.
Aurélien
A
Garros
Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
Jun
J
Nakamura
Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
Yoshitaka
Y
Hata
Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
Valerio
V
Balassone
Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
Manabu
M
Onimaru
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Gulara
G
Hajiyeva
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Amr
A
Ismail
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Yen-I
YI
Chen
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Majidah
M
Bukhari
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Yamile
Y
Haito-Chavez
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Vivek
V
Kumbhari
Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy.
Roberta
R
Maselli
Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy.
Alessandro
A
Repici
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Mouen A
MA
Khashab
D000328:Adult; D001208:Asia; D016145:Endoscopy, Digestive System / Q000379:methods*; D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States