Endoscopic Therapy Can Successfully Treat Post-POEM GERD

Endoscopic Therapy Can Successfully Treat Post-POEM GERD

Prateek Sharma, MD, FASGE, reviewing Maydeo A, et al. Endoscopy 2023 Mar 21.

Peroral endoscopic myotomy (POEM) is increasingly being used as mainline therapy for patients with achalasia. After POEM, approximately 30% to 50% of patients experience abnormal esophageal acid exposure, whereas 10% have symptomatic gastroesophageal reflux disease (GERD) and erosive esophagitis. 

This study aimed to evaluate the efficacy of endoscopic full-thickness plication (EFTP) in treating GERD after POEM through a randomized sham-controlled trial involving 60 patients. The primary endpoint was an improvement in acid exposure time (AET) below 6%, and secondary endpoints included improvements in esophagitis, GERD questionnaire (GERDQ) scores, and proton pump inhibitor (PPI) usage. 

At 3 months, 69% of patients in the EFTP group achieved improvement in AET below 6%, which was significantly more than the 10.3% of patients who achieved this in the sham group. EFTP was also statistically superior to the sham procedure in improving esophageal AET, DeMeester Scores, and all reflux episodes (P<.001). Median scores at 3 and 6 months were significantly better in the EFTP group (P<.001), and a higher proportion of patients in the sham group versus the EFTP group continued to use PPIs (72% vs 28%). No major adverse events were reported in either group.

Prateek Sharma, MD, FASGE

COMMENT

Endoscopic full-thickness plication is safe and effective in managing post-POEM GERD and led to a significant reduction in PPI use and improvement in GERD symptoms and 24-hour pH impedance findings. Endoscopic therapy can be used for the treatment of post-POEM GERD.

 

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Maydeo A, Patil G, Kamat N, et al. Endoscopic full-thickness plication for the treatment of gastroesophageal reflux after peroral endoscopic myotomy: a randomized sham-controlled study. Endoscopy 2023 Mar 21. (Epub ahead of print) (https://doi.org/10.1055/a-2040-4042)

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