Per Oral Endoscopic Myotomy (POEM) as a Salvation technique post Heller: An International Experience

Abstract

Background

The treatment for achalasia has traditionally been Heller myotomy (HM). Despite its excellent efficacy rate, a number of patients remain symptomatic post-procedure. Limited data exists as to the best management for recurrence of symptoms post HM. We present an international, multicenter experience evaluating the efficacy and safety of post-HM per-oral endoscopic myotomy (POEM).

Methods

Patients who underwent a POEM post-HM from 13 centers from January 2012 to January 2017 were included as part of a prospective registry. Technical success was defined as successful completion of the myotomy. Clinical success was defined as an Eckardt score of ≤ 3 on 12-month follow-up. Adverse events (AE) including anesthesia-related, operative, and post-operative complications were recorded.

Results

51 patients were included in the study (mean age 54.2, 47% male). Technical success was achieved in 100% of patients. Clinical success on long term follow-up was achieved in 48 patients (94%), with a mean change in Eckardt score of 6.25. Seven patients (13%) had AEs: 6 experienced peri-procedural mucosal defect treated endoscopically and 2 patients developed mediastinitis treated conservatively.

Conclusion

For patients with persistent symptoms after HM, POEM is a safe salvation technique with good short-term efficacy. Due to the challenge associated with repeat HM, POEM might become the preferred technique in this patient population. Further studies with longer follow-up are needed.

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