Peroral endoscopic myotomy (POEM) is safe and effective in the setting of prior endoscopic intervention

Ahmed Sharata, Ashwin A Kurian, Christy M Dunst, Neil H Bhayani, Kevin M Reavis, Lee L Swanström
Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract 2013, 17 (7): 1188-92

OBJECTIVE: We aimed to determine the safety and feasibility of peroral endoscopic myotomy (POEM) in the setting of prior endoscopic interventions.

PATIENTS: This study involves 40 consecutive patients undergoing POEM.

INTERVENTION: POEM was performed for esophageal motility disorders, including achalasia, nutcracker with nonrelaxing lower esophageal sphincter (LES), hypertensive lower esophageal sphincter, and diffuse esophageal spasm.

MAIN OUTCOME MEASURES: Outcome measures include length of procedure (LOP), intraoperative complications, and dysphagia relief.

RESULTS: Forty patients, with a mean age of 54 ± 19 years, underwent POEM. The pre-POEM intervention group consisted of 12 patients (nine achalasia, two nutcracker with nonrelaxing LES, and one diffuse esophageal spasm) who also had previous endoscopic treatment, while the pre-POEM non-intervention group consisted of 28 patients (22 achalasia, 3 hypertensive LES, 2 nutcracker with nonrelaxing LES, and 1 diffuse esophageal spasm). Ten patients had botox injections and two patients had large caliber balloon dilations prior to POEM. The median preoperative Eckardt score was 5 in the pre-POEM intervention group vs 6 in the pre-POEM non-intervention group (p value = 0.4). There was no statistical difference in the mean LOP (134 ± 43 vs 131 ± 41, p = 0.8) or the incidence of intraoperative complications (17 vs 3 %, p = 0.2) between the two groups. There was also no difference in the 6-month postoperative median Eckardt scores between the two groups (1 vs 1, p = 0.4).

CONCLUSION: POEM is safe and effective even following preoperative endoscopic large caliber balloon dilations or botox injection. These interventions do not seem to contribute to increased adverse intraoperative or postoperative clinical outcomes.

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