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Endoscopy 2020; 52(07): 583-588
DOI: 10.1055/a-1147-1348
Innovations and brief communications

Peroral endoscopic myotomy (POEM) for dysphagia and esophageal motor disorder after antireflux fundoplication

Jean-Michel Gonzalez
1   Service de gastroentérologie, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
,
Laurent Monino
1   Service de gastroentérologie, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
2   Department of Hepatogastroenterology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
,
Philippe Ah-Soune
3   Service d’hépato-gastroentérologie, CHG Sainte Musse, Toulon, France
,
Véronique Vitton
1   Service de gastroentérologie, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
,
Marc Barthet
1   Service de gastroentérologie, Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
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Abstract

Introduction Laparoscopic fundoplication is the treatment of severe and refractory gastroesophageal reflux disease (GERD). It induces dysphagia in 5 % – 10 % owing to a tight valve ± esophageal motility disorders (EMD), with challenging management. We assessed the first case series assessing peroral endoscopic myotomy (POEM) in such a situation.

Methods A retrospective case series including eight patients with severe dysphagia after laparoscopic fundoplication who were treated by POEM. They were assessed clinically by Eckardt and Mellow – Pinkas dysphagia scores, and by high resolution manometry (HRM). The procedure was a regular esophageal POEM, mainly posterior, including a myotomy of the wrap. The objectives were to evaluate the clinical efficacy, technical difficulties, and complications of this approach.

Results HRM showed aperistalsis in 6 /8 patients and raised lower esophageal sphincter (LES) pressure in 5 /8. The median preoperative Eckardt and dysphagia scores were 5 and 3.5, respectively. The procedure was completed in 7 /8 patients, with a clinical efficacy rate (normalization of both scores) of 75 % (6 /8). Although the submucosa seemed more fibrotic and vascularized, no severe complications occurred.

Conclusion POEM is a newly described therapeutic option to consider for managing dysphagia due to EMD after laparoscopic fundoplication.



Publication History

Received: 08 August 2019

Accepted: 10 March 2020

Article published online:
23 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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