Peroral Endoscopic Myotomy Is Safe and Effective: A 10-Year Follow-Up of Patients

Peroral Endoscopic Myotomy Is Safe and Effective: A 10-Year Follow-Up of Patients

Prateek Sharma, MD, FASGE, reviewing Modayil RJ, et al. Gastrointest Endosc 2021 May 11.

Peroral endoscopic myotomy (POEM), an endoscopic modality for managing major esophageal motility disorders, has gained popularity in the last decade. Multiple controlled studies and systematic reviews (3-5 years of follow-up) have reported a clinical success of more than 90%, along with a post-POEM GERD rate of approximately 30%. The authors of this single-center prospective study report the 10-year safety and efficacy of POEM. 

A total of 610 patients (median age, 55 years; body mass index, 26; 55.4% males) who underwent POEM between 2009 and 2019 were included in an initial pH study after POEM. A majority of the procedures were to treat achalasia (type II, 50.3%; type I, 26.2%; type III, 15.6%), whereas a lower number were for esophageal junction outflow obstruction (EGJOO, 2.21%), jackhammer esophagus (JE, 1%), or diffuse esophageal spasm (DES, 0.7%). 

Clinical success (post-POEM Eckardt score of 3), recorded annually for 7 years, was 97.6% (first year), 96.2%, 95.9%, 93.8%, 91.9%, 91.2%, and 91.2%, respectively. The mean post-POEM Eckardt score was higher in patients without achalasia (n=23; EGJOO, JE, or DES) than patients with achalasia (1.2 vs 0.8; P=.04). Accidental deep mucosal injuries were reported in 10.5% of the patients. 

In a follow-up pH study at least 3 years after the original pH study, 21 patients (3.4%) reported other significant adverse events (AEs): tunnel-opening dehiscences without leaks (n=3), delayed GI bleeding (n=8), and others (n=10); punctate esophageal perforation, narcotic-induced ileus, narcotic toxicity, aspiration pneumonia, atrial fibrillation, C difficile colitis in 2, mild pneumothorax, and 3 cases of prolonged fasting and observation in suspected AEs that did not occur in high-risk patients. None of these AEs led to invasive intervention, disability, or death. Of the patients with postprocedural GERD, 79.5% had no reflux or 1 reflux episode per week at 30 months, whereas paired pH studies at 5 and 57 months showed a reduction in positive results (67% to 43%; P=.003).

Prateek Sharma, MD, FASGE

COMMENT

In expert hands, POEM is a safe procedure demonstrating more than 90% of clinical effectiveness at long-term follow-up. Non-clinically significant adverse events are reported in <5% of the patients, and although up to 30% to 40% of patients show objective evidence of GERD, this seemed to decrease over the follow-up period.

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)

Modayil RJ, Zhang X, Rothberg B, et al. Peroral endoscopic myotomy: 10-year outcomes from a large, single-center U.S. series with high follow-up completion and comprehensive analysis of long-term efficacy, safety, objective GERD, and endoscopic functional luminal assessment. Gastroint Endosc 2021 May 11. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2021.05.014)

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