Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 7:13:a26556550.
doi: 10.1055/a-2655-6550. eCollection 2025.

Safety and efficacy of peroral endoscopic myotomy with endoscopic fundoplication compared with POEM alone: International multicenter cohort study

Michel Kahaleh  1 , Vera Hapshy  2 , Juan A Alcívar  3 , Jorge Baquerizo-Burgos  3 , Hannah Lukashok  3 , Monica R Gaidhane  1 , Iman Andalib  4 , Amy Tyberg  2 , Avik Sarkar  5 , Haroon Shahid  5 , Abid Allehibi  6 , Resheed Alkhiari  7 , Magda L Rodriguez  8 , Carmen Bautista-Altamirano  9 , Sarbelio Rodriguez  10 , Maria G Porfilio  11 , Mine Carames  12 , Juan Carlos Carames  12 , Amol Bapaye  13 , Carlos Robles-Medranda  3   14
Affiliations

Safety and efficacy of peroral endoscopic myotomy with endoscopic fundoplication compared with POEM alone: International multicenter cohort study

Michel Kahaleh et al. Endosc Int Open. .

Abstract

Background and study aims: Gastroesophageal reflux (GERD) can occur in a significant number of achalasia patients undergoing post-peroral endoscopic myotomy (POEM). POEM with endoscopic fundoplication (POEM-F) is a new endoscopic technique to treat post- POEM GERD. We conducted a multicenter cohort study to compare outcomes between POEM and POEM-F.

Patients and methods: We included patients who underwent POEM or POEM-F from six tertiary centers. Primary outcomes were: 1) clinical success, defined as post-procedure cessation or reduction of proton-pump inhibitors; 2) post procedure percent time pH < 4 and DeMeester score; and 3) post-procedure Eckardt scores. Secondary outcomes included adverse events, procedure time, and hospital stay duration.

Results: Sixty-four patients were included: 31 patients underwent POEM-F (mean age 51, 48% male), whereas 33 patients POEM (mean age 56, 58% male). Technical success was 100% in both groups. POEM-F patients achieved reduction/cessation in proton pump inhibitor use in 25 of 31 patients (80%); POEM patients in eight of 33 (24%) ( P ≤ 0.00001). Percent time with pH < 4 was significantly lower in the POEM-F group (2.75 +/- 2.53 vs 9.3 +/- 3.6 min, P ≤ 0.0001). Post-procedure DeMeester scores were lower (< 14.7) in POEM-F (mean 9.6) than POEM (mean 15.8) ( P ≤ 0.0011). There were three mucosal injuries in the POEM-F group and four in the POEM group. Hospital stay duration and procedure time did not differ between groups. In the POEM group, four patients required Dor fundoplication. No repeat interventions were recommended for the POEM- F group at 6-month follow-up.

Conclusions: POEM-F achieves statistically significant improvement in post- POEM GERD compared with POEM alone.

Keywords: Endoscopy Upper GI Tract; Motility / achalasia; POEM.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Dr. Kahaleh has received grants from BSC, Fuji Erbe, Pentax, Medtronic, and Microtech. He is a consultant for BSC, Creo, and Microtech. He is the CEO for Innovative Digestive Heatlh Education and Reseach inc. (non-profit). He is the CEO for Foundation for Interventional and Therapeutic Endoscopy (FITE, non-profit). Dr. Gaidhane is the COO for Innovative Digestive Heatlh Education and Reseach inc. (non-profit). She is the CFO for Foundation for Interventional and Therapeutic Endoscopy (FITE, non-profit). She is also a consultant for the Free Space Project. Dr. Gaidhane has periodically been a consultant for Guidepoint for the past 3 years.

Figures

Fig. 1
Fig. 1
Opening of the gastric serosa.
Fig. 2
Fig. 2
Entrance into the peritoneum with liver seen facing the stomach.
Fig. 3
Fig. 3
Retroflexion of the esogastric junction before fundoplication simulation.
Fig. 4
Fig. 4
Retroflexion of the esogastric junction during fundoplication simulation.
Fig. 5
Fig. 5
Marking of the stomach with diathermy.
Fig. 6
Fig. 6
Clips over endoloop at the stomach level previously marked.
Fig. 7
Fig. 7
Clips over endoloop at the myotomy site.
Fig. 8
Fig. 8
Endoloop tightening.
Fig. 9
Fig. 9
Forest plot of relative risk (RR) of PPI reduction and GERD symptoms after POEM-F compared with traditional POEM.
See this image and copyright information in PMC

References

    1. Costantini M, Salvador R, Costantini A. Esophageal achalasia: pros and cons of the treatment options. World J Surgery. 2022;46:1554–1560. doi: 10.1007/s00268-022-06495-z. - DOI - PMC - PubMed
    1. Chavez RD, Marino D, Kahaleh M et al. Endoscopic treatment of reflux: a comprehensive review. Journal of Clinical Gastroenterology. 2022;56:831–843. - PubMed
    1. Inoue H, Minami H, Kobayashi Y et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–271. doi: 10.1055/s-0029-1244080. - DOI - PubMed
    1. Pandolfino JE, Gawron AJ. Achalasia: a systematic review. JAMA. 2015;313:1841–1852. doi: 10.1001/jama.2015.2996. - DOI - PubMed
    1. Kumbhari V, Familiari P, Bjerregaard NC et al. Gastroesophageal reflux after peroral endoscopic myotomy: a multicenter case–control study. Endoscopy. 2017;49:634–642. doi: 10.1055/s-0043-105485. - DOI - PubMed

LinkOut - more resources