Per-oral endoscopic myotomy; Achalasia;Gastroesophageal reflux

AbstractBackground and aims Per-oral endoscopic myotomy(POEM) is becoming a standard treatment for achalasia.Long-term efficacy and the rate of post-POEM refluxshould be further investigated. The main aim of this studywas to analyze safety and mid-term (12 and 24 months)clinical outcomes of POEM.Methods Data on single tertiary center procedures werecollected prospectively. The primary outcome was treatmentsuccess defined as an Eckardt score\3 at 12 and24 months. A total of 155 consecutive patients withachalasia underwent POEM; 133 patients were includedinto the analysis (22 patients will be analyzed separately aspart of a multicenter randomized clinical trial).Results POEM was successfully completed in 132 (99.2%)patients, and the mean length of the procedure was69.8 min (range 31?136). One patient underwent a drainagefor pleural effusion; no other serious adverse eventsoccurred. Treatment success at 3, 12, and 24 months wasobserved in 95.5% (CI 89.6?98.1), 93.4% (86.5?96.8), and84.0% (71.4?91.4) of patients, respectively. A total of 11patients (8.3%) reported initial treatment failure (n = 5) orlater recurrence (n = 6). The majority of relapses occurredin patients with achalasia type I (16.7 vs. 1.1% achalasiatype II vs. 0% achalasia type III; p\0.05). At 12 months,post-POEM reflux symptoms were present in 29.7% ofpatients. At 3 months, mild reflux esophagitis was diagnosedin 37.6% of patients, and pathological gastroesophagealreflux was detected in 41.5% of patients. A totalof 37.8% of patients had been treated with a proton pumpinhibitor.Conclusion POEM resulted in greater than 90% treatmentsuccess at 12 months which tends to decrease to 84% after2 years. More than one-third of the patients had mild refluxsymptoms and/or mild esophagitis.