Statement for gastroesophageal reflux disease after peroral endoscopic myotomy from an international multicenter experience

Abstract

It has been 10 years since peroral endoscopic myotomy (POEM) was reported for the first time, and POEM has currently become the standard treatment for achalasia and related disorders globally because it is less invasive and has a higher curative effect than conventional therapeutic methods. However, there are limited studies comparing the long-term outcomes of POEM with those of conventional therapeutic methods, particularly in the occurrence of gastroesophageal reflux disease (GERD) after therapy. With this background, we held a consensus meeting to discuss the pathophysiology and management of GERD after POEM based on published papers and experiences of each expert and to discuss the prevention of GERD and dealing with anti-acid drug refractory GERD. This meeting was held on April 27, 2018 in Tokyo to establish statements and finalize the recommendations using the modified Delphi method. This manuscript presents eight statements regarding GERD after POEM.

Keywords: Achalasia; GERD; Myotomy.

Fig. 1

The image of double-scope method. A second endoscope was inserted into the stomach to examine the cardia region. If the procedure reached the gastric side, the light from the main scope within the submucosal space was visible through the second scope in the stomach

Fig. 2

Endoscopic finding of double scope. The length of myotomy in gastric side can be measured based on the diameter of second scope