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Endoscopy. 2017 Jul;49(7):634-642. doi: 10.1055/s-0043-105485. Epub 2017 May 4.

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

Author information

1
Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States.
2
Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy.
3
Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
4
Gastroenterologie, Pavillon H Hôpital Edouard Herriot, Lyon, France.
5
Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States.
6
Department of Gastroenterology, CHA Bundang Medical Center, Seongnam, Korea.
7
Gastroenterology, King's College Hospital, London, United Kingdom.
8
Gastroenterologie, University of Lyon, Lyon, France.
9
Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, United States.
10
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States.
11
IHU-USIAS, University of Strasbourg, France.

Abstract

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.

PMID:
28472834
DOI:
10.1055/s-0043-105485
[Indexed for MEDLINE]

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