title: Long-term outcome of peroral endoscopic myotomy for esophageal achalasia in patients with previous Heller myotomy.
abstract: Peroral endoscopic myotomy (POEM) is an emerging procedure in the treatment of esophageal achalasia, a primary motility disorder. However, the long-term outcome of POEM in patients, who have previously undergone a Heller myotomy, is unknown.
  
  
  
  Using a local database, we identified patients with esophageal achalasia, who underwent POEM. We compared patients with a previous Heller myotomy to those, who had received none or only non-surgical therapy prior to the POEM procedure. We conducted follow-up examinations at 3, 12, and 24 months following the procedure.
  
  
  
  We included 66 consecutive patients undergoing POEM for achalasia, of which 14 (21.2 %) had undergone a prior Heller myotomy. In both groups, the preoperative Eckardt score was 7. Postoperatively, the non-Heller group experienced a more pronounced symptom relief at both 3-, 12-, and 24-month follow-up compared with the Heller group, and there was a tendency for the effect of POEM to reduce over time. We suggest that there is a correlation between preoperative measurements of gastroesophageal sphincter pressures and the chance of a successful POEM.
  
  
  
  POEM has a place in the treatment of esophageal achalasia in patients with a prior Heller myotomy and persistent symptoms as it is a safe procedure with acceptable long-term results.
authors.affiliation: Department of Surgery, Section for Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, L-research, Building 1C, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark.
authors.forename: Helle Ø
authors.initials: HØ
authors.lastname: Kristensen
authors.affiliation: Department of Surgery, Section for Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, L-research, Building 1C, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark. jakob.kirkegaard@auh.rm.dk.
authors.forename: Jakob
authors.initials: J
authors.lastname: Kirkegård
authors.affiliation: Department of Surgery, Section for Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, L-research, Building 1C, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark.
authors.forename: Daniel Willy
authors.initials: DW
authors.lastname: Kjær
authors.affiliation: Department of Surgery, Section for Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, L-research, Building 1C, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark.
authors.forename: Frank Viborg
authors.initials: FV
authors.lastname: Mortensen
authors.affiliation: Department of Surgery, Section for Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, L-research, Building 1C, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark.
authors.forename: Rastislav
authors.initials: R
authors.lastname: Kunda
authors.affiliation: Department of Surgery, Section for Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, L-research, Building 1C, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark.
authors.forename: Niels Christian
authors.initials: NC
authors.lastname: Bjerregaard
mesh_terms: D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D000074434:Heller Myotomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D012086:Reoperation; D016896:Treatment Outcome; D055815:Young Adult
keywords: Achalasia; Esophagus; Heller myotomy; Motility disorder; POEM; Peroral endoscopic myotomy