title: A multicenter international registry of redo per-oral endoscopic myotomy (POEM) after failed POEM.
abstract: OBJECTIVE
  Per-oral endoscopic myotomy (POEM) has become an accepted treatment for patients with achalasia. Despite its excellent efficacy rate of greater than 80%, a small percentage of patients remain symptomatic after the procedure. Limited data exist as to the best management for recurrence of symptoms after POEM. We present the first international, multicenter experience on the efficacy and safety of a repeat POEM in the management of achalasia.
  
  
  METHODS
  Patients who underwent a redo POEM from 15 centers in 9 countries were included in a dedicated registry. Technical success was defined as successful completion of a second myotomy. Clinical success was defined as an Eckardt score of less than or equal to 3 after the second myotomy. Adverse events including anesthesia-related, operative, and postoperative adverse events were recorded.
  
  
  RESULTS
  Forty-six patients were included in the study. The average age was 49.3 ± 16.78 years. Twenty (45%) patients were male. The mean pre-redo-POEM Eckardt score was 4.3 ± 2.48. Technical success was achieved in 46 (100%) patients. Clinical success was achieved in 41 patients (85%). The average post-POEM Eckardt score was 1.64 ± 1.67, with a significant difference of 2.58 (P < .00001). Eight patients (17%) had adverse events consisting of procedural bleeding, all managed endoscopically. There were no deaths. No POEMs were aborted or required surgical conversion or assistance.
  
  
  CONCLUSIONS
  For patients with persistent symptoms after POEM, repeat POEM appears to be an efficacious and safe technique. Further randomized trials comparing redo POEM versus Heller should be considered. (Clinical trial registration number: NCT02162589.).
authors.affiliation: Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Tyberg
authors.affiliation: GastroZentrum Hirslanden, Klinik Hirslanden, Zurich, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Seewald
authors.affiliation: Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.affiliation: Gastroenterology, Juarez Hospital, Mexico City, Mexico.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Martinez
authors.affiliation: Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA.
authors.forename: Amit P
authors.initials: AP
authors.lastname: Desai
authors.affiliation: Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA.
authors.forename: Nikhil A
authors.initials: NA
authors.lastname: Kumta
authors.affiliation: Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA.
authors.forename: Arnon
authors.initials: A
authors.lastname: Lambroza
authors.affiliation: Digestive and Liver Disease, Columbia University Medical Center, New York, New York, USA.
authors.forename: Amrita
authors.initials: A
authors.lastname: Sethi
authors.affiliation: Providence Portland Cancer Center, Portland, Oregon, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Reavis
authors.affiliation: Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA.
authors.forename: Ketisha
authors.initials: K
authors.lastname: DeRoche
authors.affiliation: Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.affiliation: Division of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Talbot
authors.affiliation: Division of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Payal
authors.initials: P
authors.lastname: Saxena
authors.affiliation: Gastroenterology, Juarez Hospital, Mexico City, Mexico.
authors.forename: Felipe
authors.initials: F
authors.lastname: Zamarripa
authors.affiliation: Department of Gastroenterology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Maximilien
authors.initials: M
authors.lastname: Barret
authors.affiliation: Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Eleftheriadis
authors.affiliation: Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
authors.forename: Valerio
authors.initials: V
authors.lastname: Balassone
authors.affiliation: Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
authors.forename: Haruhiro
authors.initials: H
authors.lastname: Inoue
authors.affiliation: Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000328:Adult; D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000074433:Myotomy / Q000379:methods*; D057605:Natural Orifice Endoscopic Surgery; D012042:Registries; D012086:Reoperation; D017211:Treatment Failure; D016896:Treatment Outcome