Modified POEM Technique Can Be Effective for Postfundoplication Dysphagia
Prateek Sharma, MD, FASGE, reviewing Gonzalez JM, et al. Gastrointest Endosc 2023 Jun 27.
Laparoscopic fundoplication (LF) as a treatment option for GERD involves 3 techniques based on the wrap extension: Nissen (total, 360°), Toupet (posterior, 270°), and Dor after Heller intervention (anterior, 170°). During these procedures, a valve is created by wrapping the fundus around the esophagogastric junction and suturing it to achieve antireflux effects. LF can lead to persistent dysphagia in 5% to 10% of cases. A modified peroral endoscopic myotomy (POEM) technique that includes an incision in the valve is a new therapeutic option.
In this retrospective study, conducted on patients experiencing refractory dysphagia after LF, patients underwent POEM and a complete wrap incision. Patient assessment involved Eckardt and dysphagia scores. The study included 26 patients with a mean age of 57.3 ± 15.6 years and a mean follow-up of 25.3 ± 17.6 months.
The technical success rate was 96%, and clinical success was achieved in 84.6% of cases. Among the cases that failed, one patient underwent a Lewis-Santy procedure, two required dilations, and one was lost to follow-up. Three late recurrences were managed endoscopically. About 19% of patients experienced GERD recurrence, which mostly improved with proton pump inhibitors.
COMMENTPOEM combined with valve incision may be an option for patients with postfundoplication refractory dysphagia. Additional larger multicentric studies are required to further evaluate clinical efficacy.
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)
Gonzalez JM, Barthet M, Debourdeau A, Monino L, Vitton V. Peroral endoscopic myotomy and valve section for treatment of persistent and disabling dysphagia after laparoscopic fundoplication. Gastrointest Endosc 2023 Jun 27. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2023.06.027)
