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Gastrointest Endosc. 2017 Jun;85(6):1208-1211. doi: 10.1016/j.gie.2016.10.015. Epub 2016 Oct 15.

A multicenter international registry of redo per-oral endoscopic myotomy (POEM) after failed POEM.

Author information

1
Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA.
2
GastroZentrum Hirslanden, Klinik Hirslanden, Zurich, Switzerland.
3
Gastroenterology, Juarez Hospital, Mexico City, Mexico.
4
Digestive and Liver Disease, Columbia University Medical Center, New York, New York, USA.
5
Providence Portland Cancer Center, Portland, Oregon, USA.
6
Division of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
7
Department of Gastroenterology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.
8
Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.

Abstract

BACKGROUND AND AIMS:

Per-oral endoscopic myotomy (POEM) has become an accepted treatment for patients with achalasia. Despite its excellent efficacy rate of greater than 80%, a small percentage of patients remain symptomatic after the procedure. Limited data exist as to the best management for recurrence of symptoms after POEM. We present the first international, multicenter experience on the efficacy and safety of a repeat POEM in the management of achalasia.

METHODS:

Patients who underwent a redo POEM from 15 centers in 9 countries were included in a dedicated registry. Technical success was defined as successful completion of a second myotomy. Clinical success was defined as an Eckardt score of less than or equal to 3 after the second myotomy. Adverse events including anesthesia-related, operative, and postoperative adverse events were recorded.

RESULTS:

Forty-six patients were included in the study. The average age was 49.3 ± 16.78 years. Twenty (45%) patients were male. The mean pre-redo-POEM Eckardt score was 4.3 ± 2.48. Technical success was achieved in 46 (100%) patients. Clinical success was achieved in 41 patients (85%). The average post-POEM Eckardt score was 1.64 ± 1.67, with a significant difference of 2.58 (P < .00001). Eight patients (17%) had adverse events consisting of procedural bleeding, all managed endoscopically. There were no deaths. No POEMs were aborted or required surgical conversion or assistance.

DISCUSSION:

For patients with persistent symptoms after POEM, repeat POEM appears to be an efficacious and safe technique. Further randomized trials comparing redo POEM versus Heller should be considered. (Clinical trial registration number: NCT02162589.).

PMID:
27756611
DOI:
10.1016/j.gie.2016.10.015
[Indexed for MEDLINE]

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