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Clin Gastroenterol Hepatol. 2017 Feb 9. pii: S1542-3565(17)30144-1. doi: 10.1016/j.cgh.2017.01.031. [Epub ahead of print]

Efficacy and Safety of Peroral Endoscopic Myotomy for Treatment of Achalasia After Failed Heller Myotomy.

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  • 1Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
  • 2Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
  • 3Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.
  • 4Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
  • 5Surat Institute of Digestive Sciences, Surat, India.
  • 6Gastroenterology and Endoscopy Unit, Digestive Disease Department, L Pavillon-Edouard Herriot Hospital, Lyon, France.
  • 7Université de Lyon and Hospices Civils de Lyon, Digestive Physiology, E Herriot Hospital, Lyon, France; INSERM U1032, Lyon, France.
  • 8Division of Gastroenterology and Hepatology and Nutrition, University of Florida College of Medicine, Gainesville, Florida.
  • 9Department of Gastrointestinal and Endocrine Surgery, University of Strasbourg, Strasbourg, France.
  • 10Department of Surgery, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts.
  • 11Division of Gastroenterology, Department of Medicine, Baystate Medical Center.
  • 12Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
  • 13Department of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, Australia.
  • 14University of New South Wales, Sydney, New South Wales, Australia.
  • 15Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
  • 16Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
  • 17Department of Gastroenterology, Humanitas Research Hospital, Milano, Italy.
  • 18Department of Gastroenterology, Humanitas Research Hospital, Milano, Italy; Humanitas University, Milano, Italy.
  • 19Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland. Electronic address:



In patients with persistent symptoms after Heller myotomy (HM), treatment options include repeat HM, pneumatic dilation, or peroral endoscopic myotomy (POEM). We evaluated the efficacy and safety of POEM in patients with achalasia with prior HM vs without prior HM.


We conducted a retrospective cohort study of 180 patients with achalasia who underwent POEM at 13 tertiary centers worldwide, from December 2009 through September 2015. Patients were divided into 2 groups: those with prior HM (HM group, exposure; n = 90) and those without prior HM (non-HM group; n = 90). Clinical response was defined by a decrease in Eckardt scores to 3 or less. Adverse events were graded according to criteria set by the American Society for Gastrointestinal Endoscopy. Technical success, clinical success, and rates of adverse events were compared between groups. Patients were followed up for a median of 8.5 months.


POEM was technically successful in 98% of patients in the HM group and in 100% of patients in the non-HM group (P = .49). A significantly lower proportion of patients in the HM group had a clinical response to POEM (81%) than in the non-HM group (94%; P = .01). There were no significant differences in rates of adverse events between the groups (8% in the HM group vs 13% in the non-HM group; P = .23). Symptomatic reflux and reflux esophagitis after POEM were comparable between groups.


POEM is safe and effective for patients with achalasia who were not treated successfully by prior HM. Although the rate of clinical success in patients with prior HM is lower than in those without prior HM, the safety profile of POEM is comparable between groups.


Achalasia; Heller Myotomy; Outcome; Peroral Endoscopic Myotomy; Recurrence; Surgery; Therapy

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