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. 2018 Jan;87(1):95-101.
doi: 10.1016/j.gie.2017.04.036. Epub 2017 May 3.

Management of recurrent symptoms after per-oral endoscopic myotomy in achalasia

Froukje B van Hoeij  1 , Fraukje A Ponds  1 , Yuki Werner  2 , Joel M Sternbach  3 , Paul Fockens  1 , Barbara A Bastiaansen  1 , André J P M Smout  1 , John E Pandolfino  3 , Thomas Rösch  2 , Albert J Bredenoord  1
Affiliations

Management of recurrent symptoms after per-oral endoscopic myotomy in achalasia

Froukje B van Hoeij et al. Gastrointest Endosc. 2018 Jan.

Abstract

Background and aims: Per-oral endoscopic myotomy (POEM) has been rapidly gaining ground as a treatment for achalasia. Although POEM is a safe and effective treatment, a subset of patients has persistent or recurrent symptoms after POEM. This study aimed to examine the efficacy of different retreatments after failed POEM.

Methods: POEM was performed on 441 patients with achalasia at 3 tertiary-care hospitals between 2010 and 2015. A review of prospectively collected data was conducted. All patients with achalasia with significant persistent or recurrent symptoms within 3 years after POEM, defined as an Eckardt symptom score >3, were included.

Results: Forty-three of 441 patients (9.8%) had persistent or recurrent symptoms after POEM, of which 34 (8%) received 1 or more retreatments. Retreatment with laparoscopic Heller myotomy and retreatment with POEM showed a modest efficacy of 45% and 63%, respectively, whereas pneumatic dilatation showed a poor efficacy of only 0% to 20%, depending on the size of the balloon. Male patients were more likely to have retreatment failure than female patients (P = .038).

Conclusions: In patients with achalasia with persistent or recurrent symptoms after failed POEM, retreatment with laparoscopic Heller myotomy or retreatment with POEM has a higher efficacy than retreatment with pneumatic dilatations. Failure of retreatment occurred more often in male patients.

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