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Surgical Endoscopy

, Volume 32, Issue 3, pp 1293–1302 | Cite as

Per-oral endoscopic myotomy (POEM): mid-term efficacy and safety

  • Jan Martinek
  • Hana Svecova
  • Zuzana Vackova
  • Radek Dolezel
  • Ondrej Ngo
  • Jana Krajciova
  • Eva Kieslichova
  • Radim Janousek
  • Alexander Pazdro
  • Tomas Harustiak
  • Lucie Zdrhova
  • Pavla Loudova
  • Petr Stirand
  • Julius Spicak
Article

Abstract

Background and aims

Per-oral endoscopic myotomy (POEM) is becoming a standard treatment for achalasia. Long-term efficacy and the rate of post-POEM reflux should be further investigated. The main aim of this study was to analyze safety and mid-term (12 and 24 months) clinical outcomes of POEM.

Methods

Data on single tertiary center procedures were collected prospectively. The primary outcome was treatment success defined as an Eckardt score < 3 at 12 and 24 months. A total of 155 consecutive patients with achalasia underwent POEM; 133 patients were included into the analysis (22 patients will be analyzed separately as part of a multicenter randomized clinical trial).

Results

POEM was successfully completed in 132 (99.2%) patients, and the mean length of the procedure was 69.8 min (range 31–136). One patient underwent a drainage for pleural effusion; no other serious adverse events occurred. Treatment success at 3, 12, and 24 months was observed in 95.5% (CI 89.6–98.1), 93.4% (86.5–96.8), and 84.0% (71.4–91.4) of patients, respectively. A total of 11 patients (8.3%) reported initial treatment failure (n = 5) or later recurrence (n = 6). The majority of relapses occurred in patients with achalasia type I (16.7 vs. 1.1% achalasia type II vs. 0% achalasia type III; p<0.05). At 12 months, post-POEM reflux symptoms were present in 29.7% of patients. At 3 months, mild reflux esophagitis was diagnosed in 37.6% of patients, and pathological gastroesophageal reflux was detected in 41.5% of patients. A total of 37.8% of patients had been treated with a proton pump inhibitor.

Conclusion

POEM resulted in greater than 90% treatment success at 12 months which tends to decrease to 84% after 2 years. More than one-third of the patients had mild reflux symptoms and/or mild esophagitis.

Keywords

Per-oral endoscopic myotomy Achalasia Gastroesophageal reflux 

Abbreviations

HRM

High-resolution manometry

EGJ

Esophagogastric junction

IRP

Integrated relaxation pressure

LES

Lower esophageal sphincter

LHM

Laparoscopic Heller myotomy

PD

Pneumatic dilatation

POEM

Per-oral endoscopic myotomy

TBE

Timed barium esophagogram

QoL

Quality of life

Notes

Acknowledgements

The authors would like to express their thanks to Mrs. Jana Rauvolfova, Mrs. Gabriela Petranova, Mr. Tomas Hobza and Mr. Petr Haffner for their help and support of our POEM program.

Funding

There was no financial support from other parties.

Author’s Contribution

J. Martinek: study concept, design, analysis of data, performing POEM, drafting the manuscript. H. Svecova, Z. Vackova, J. Krajciova, P. Loudova, L. Zdrhova: data acquisition and analysis, critical revision of the manuscript. R. Dolezel, T. Harustiak, A. Pazdro: study design, data acquisition and analysis, critical revision of the manuscript. P. Stirand: POEM performance, critical revision of the manuscript. O. Ngo: statistical analysis. E. Kieslichova, R. Janousek: analysis of complications and X-ray findings. J. Spicak: study concept and critical revision of the manuscript.

Compliance with Ethical Standards

Disclosures

Jan Martinek, Hana Svecova, Zuzana Vackova, Radek Dolezel, Ondrej Ngo, Jana Krajciova, Eva Kieslichova, Radim Janousek, Alexander Pazdro, Tomas Harustiak, Lucie Zdrhova, Pavla Loudova, Petr Stirand, Julius Spicak have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Jan Martinek
    • 1
    • 9
    • 10
  • Hana Svecova
    • 1
  • Zuzana Vackova
    • 1
  • Radek Dolezel
    • 2
  • Ondrej Ngo
    • 3
  • Jana Krajciova
    • 1
  • Eva Kieslichova
    • 4
  • Radim Janousek
    • 5
  • Alexander Pazdro
    • 6
  • Tomas Harustiak
    • 6
  • Lucie Zdrhova
    • 7
  • Pavla Loudova
    • 8
  • Petr Stirand
    • 1
  • Julius Spicak
    • 1
  1. 1.Department of Hepatogastroenterology, Institute for Clinical and Experimental MedicineIKEMPrague 4Czech Republic
  2. 2.Department of SurgeryCharles University, Military University HospitalPragueCzech Republic
  3. 3.Institute of Biostatistics and Analyses, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
  4. 4.Department of Anesthesiology and Intensive CareIKEMPragueCzech Republic
  5. 5.Department of RadiologyIKEMPragueCzech Republic
  6. 6.3rd Department of Surgery, First Faculty of MedicineCharles University and University Hospital MotolPragueCzech Republic
  7. 7.Department of Internal Medicine, University Hospital PlzenCharles UniversityPilsenCzech Republic
  8. 8.Department of GastroenterologyHospital KolinKolinCzech Republic
  9. 9.Institute of PhysiologyCharles UniversityPragueCzech Republic
  10. 10.Faculty of MedicineOstrava UniversityOstravaCzech Republic

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