Outcomes of 100 Patients More Than 4 Years After POEM for Achalasia

摘要

Objective: We aim to describe the long-term follow-up data from our institution's POEM experience. Summary Background Data: Per-oral endoscopic myotomy (POEM) is a well-established endoscopic therapy for achalasia with excellent short-term efficacy, but long-term outcomes data are limited. Methods: Patients older than 4?years removed from POEM for treatment of achalasia were studied. Clinical success was defined as an Eckardt Symptom (ES) score ≤3 and freedom from reintervention for achalasia. Patients underwent esophagogastroduodenoscopy (EGD), high-resolution manometry, impedance planimetry, and timed barium esophagram (TBE) preoperatively and at least 4?years postoperatively. Objective gastroesophageal reflux disease (GERD) was defined LA Grade B or worse esophagitis on EGD. Results: One hundred and nineteen consecutive patients were included. Five patients died or had catastrophic events unrelated to achalasia or POEM. One hundred of the remaining patients (88%, 100/114) had long-term data available. Clinical follow-up for all patients was greater than 4?years postoperatively and the mean was 55?months. Mean current ES was significantly improved from preop (n = 100, 1?±?1 vs 7?±?2, P 3 and 4 patients required procedural reintervention on the lower esophageal sphincter. Reinterventions were successful in 75% of patients (3/4), with current ES ≤3. The rate of objective GERD was 33% (15/45). Esophageal physiology was improved with a decrease in median integrated relaxation pressure (11?±?4 vs 33?±?15?mm Hg, P < 0.001), a decrease in median TBE column height (3?±?3 vs 13?±?8?cm, P < 0.001), and an increase in median distensibility index (5.1?±?2 vs 1.1?±?1?mm~(2)/mm Hg, P < 0.001). Conclusions: POEM provides durable symptom relief and improvement in physiologic esophagogastric junction relaxation parameters over 4.5?years postoperatively. Reinterventions are rare and effective.