Gastroesophageal reflux after peroral endoscopic myotomy: a multicenter case-control study

Vivek Kumbhari, Pietro Familiari, Niels Christian Bjerregaard, Mathieu Pioche, Edward Jones, Weon Jin Ko, Bu Hayee, Anna Cali, Saowanee Ngamruengphong, Francois Mion, Ruben Hernaez, Sabine Roman, Alan H Tieu, Mohamad El Zein, Tokunbo Ajayi, Amyn Haji, Joo Young Cho, Jeffrey Hazey, Kyle A Perry, Thierry Ponchon, Rastislav Kunda, Guido Costamagna, Mouen A Khashab
Endoscopy 2017, 49 (7): 634-642
Background and study aims  The variables associated with gastroesophageal reflux (GER) after peroral endoscopic myotomy (POEM) are largely unknown. This study aimed to: 1) identify the prevalence of reflux esophagitis and asymptomatic GER in patients who underwent POEM, and 2) evaluate patient and intraprocedural variables associated with post-POEM GER. Patients and methods  All patients who underwent POEM and subsequent objective testing for GER (pH study with or without upper gastrointestinal [GI] endoscopy) at seven tertiary academic centers (one Asian, two US, four European) were included. Patients were divided into two groups: 1) DeMeester score ≥ 14.72 (cases) and 2) DeMeester score of < 14.72 (controls). Asymptomatic GER was defined as a patient with a DeMeester score ≥ 14.72 who was not consuming proton pump inhibitor (PPI). Results  A total of 282 patients (female 48.2 %, Caucasian 84.8 %; mean body mass index 24.1 kg/m2 ) were included. Clinical success was achieved in 94.3 % of patients. GER evaluation was completed after a median follow-up of 12 months (interquartile range 10 - 24 months). A DeMeester score of ≥ 14.72 was seen in 57.8 % of patients. Multivariable analysis revealed female sex to be the only independent association (odds ratio 1.69, 95 % confidence interval 1.04 - 2.74) with post-POEM GER. No intraprocedural variables were associated with GER. Upper GI endoscopy was available in 233 patients, 54 (23.2 %) of whom were noted to have reflux esophagitis (majority Los Angeles Grade A or B). GER was asymptomatic in 60.1 %. Conclusion  Post-POEM GER was seen in the majority of patients. No intraprocedural variables were identified to allow for potential alteration in procedural technique.

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