PDF herunterladen
Endoscopy 2021; 53(11): 1114-1121
DOI: 10.1055/a-1332-5911
Original article

Single-session endoscopic fundoplication after peroral endoscopic myotomy (POEM+F) for prevention of post gastroesophageal reflux – 1-year follow-up study

Amol Bapaye 
Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
,
Parag Dashatwar
Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
,
Siddharth Dharamsi
Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
,
Rajendra Pujari
Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
,
Harshal Gadhikar
Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Background Peroral endoscopic myotomy (POEM) is an established treatment for achalasia cardia; however, post-POEM gastroesophageal reflux (GER) remains a significant problem. Concomitant endoscopic fundoplication following POEM (POEM + F) was recently described to reduce post-POEM GER. This single-center study reports short-term outcomes of POEM + F.

Methods This was a retrospective analysis of a prospectively maintained database of patients undergoing POEM + F. Abstracted data included demographics, achalasia type, pre-POEM Eckardt score, prior therapy, follow-up. Follow-up assessment was 3-monthly for 1 year and included post-POEM Eckardt score, GerdQ score, wrap integrity and esophagitis on esophagogastroduodenoscopy, and pH studies. GER was defined according to Lyon Consensus.

Results 25 patients underwent POEM + F (mean age 40.1 years [standard deviation (SD) 13.7]; 12 females). POEM + F was technically successful in 23/25 (92.0 %). Significant dysphagia improvement was seen in all 25 patients (mean pre- and post-POEM Eckardt scores 8.21 [SD 1.08] and 0.1 [SD 0.3], respectively; P = 0.001). Mean total procedure and fundoplication times were 115.6 (SD 27.2) minutes and 46.7 (SD 12.4) minutes, respectively; times reduced significantly after the initial five cases. Median follow-up was 12 months (interquartile range [IQR] 9–13). Intact wrap was seen in 19/23 (82.6 %). GER (abnormal esophageal acid exposure time [EAET]) was seen in 2/18 (11.1 %) and there was one reported GerdQ > 8. Borderline GER (asymptomatic grade A esophagitis, normal EAET) was identified in 4/22 (18.2 %). Three (12.0 %) minor delayed adverse events occurred but required no intervention.

Conclusions POEM + F was safe and reproducible. At 12 months’ follow-up, incidence of post-POEM + F GER was low and acceptable.

Table s1, s2, Fig. s1, s2



Publikationsverlauf

Eingereicht: 06. Juni 2020

Angenommen: 08. Dezember 2020

Accepted Manuscript online:
08. Dezember 2020

Artikel online veröffentlicht:
18. Februar 2021

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Zaninotto G, Bennett C, Boeckxstaens G. et al. The 2018 ISDE achalasia guidelines. Dis Esophagus 2018; 31
    CrossrefPubMedSuche in Google Scholar
  • 2 Khashab MA, Vela MF, Thosani N. et al. ASGE guideline on the management of achalasia. Gastrointest Endosc 2020; 91: 213-227
    CrossrefPubMedSuche in Google Scholar
  • 3 Ramchandani M, Nageshwar Reddy D, Nabi Z. et al. Management of achalasia cardia: expert consensus statements. J Gastroenterol Hepatol 2018; 33: 1436-1444
    CrossrefPubMedSuche in Google Scholar
  • 4 Bapaye A, Korrapati SK, Dharamsi S. et al. Third space endoscopy: lessons learnt from a decade of submucosal endoscopy. J Clin Gastroenterol 2020; 54: 114-129
    CrossrefPubMedSuche in Google Scholar
  • 5 Inoue H, Sato H, Ikeda H. et al. Per-oral endoscopic myotomy: a series of 500 patients. J Am Coll Surg 2015; 221: 256-264
    CrossrefPubMedSuche in Google Scholar
  • 6 Stavropoulos SN, Modayil RJ, Friedel D. et al. The International Per Oral Endoscopic Myotomy Survey (IPOEMS): a snapshot of the global POEM experience. Surg Endosc 2013; 27: 3322-3338
    CrossrefPubMedSuche in Google Scholar
  • 7 Ngamruengphong S, Inoue H, Ujiki MB. et al. Efficacy and safety of peroral endoscopic myotomy for treatment of achalasia after failed Heller myotomy. Clin Gastroenterol Hepatol 2017; 15: 1531-1537
    CrossrefPubMedSuche in Google Scholar
  • 8 Ponds FA, Fockens P, Lei A. et al. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia: a randomized clinical trial. JAMA 2019; 322: 134-144
    CrossrefPubMedSuche in Google Scholar
  • 9 Schlottmann F, Luckett DJ, Fine J. et al. Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis. Ann Surg 2018; 267: 451-460
    CrossrefPubMedSuche in Google Scholar
  • 10 Werner YB, Hakanson B, Martinek J. et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. N Engl J Med 2019; 381: 2219-2229
    CrossrefPubMedSuche in Google Scholar
  • 11 Repici A, Fuccio L, Maselli R. et al. GERD after per-oral endoscopic myotomy as compared with Heller’s myotomy with fundoplication: a systematic review with meta-analysis. Gastrointest Endosc 2018; 87: 934-943
    CrossrefPubMedSuche in Google Scholar
  • 12 Kumbhari V, Familiari P, Bjerregaard NC. et al. Gastroesophageal reflux after peroral endoscopic myotomy: a multicenter case-control study. Endoscopy 2017; 49: 634-642
    Thieme ConnectPubMedSuche in Google Scholar
  • 13 Rosch T, Repici A, Boeckxstaens G. Will reflux kill POEM?. Endoscopy 2017; 49: 625-628
    Thieme ConnectPubMedSuche in Google Scholar
  • 14 Rebecchi F, Allaix ME, Schlottmann F. et al. Laparoscopic Heller myotomy and fundoplication: what is the evidence?. Am Surg 2018; 84: 481-488
    CrossrefPubMedSuche in Google Scholar
  • 15 Di Corpo M, Farrell TM, Patti MG. Laparoscopic Heller myotomy: a fundoplication is necessary to control gastroesophageal reflux. J Laparoendosc Adv Surg Tech A 2019; 29: 721-725
    CrossrefPubMedSuche in Google Scholar
  • 16 Campos GM, Vittinghoff E, Rabl C. et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 2009; 249: 45-57
    CrossrefPubMedSuche in Google Scholar
  • 17 von Renteln D, Inoue H, Minami H. et al. Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol 2012; 107: 411-417
    CrossrefPubMedSuche in Google Scholar
  • 18 Familiari P, Greco S, Gigante G. et al. Gastroesophageal reflux disease after peroral endoscopic myotomy: analysis of clinical, procedural and functional factors, associated with gastroesophageal reflux disease and esophagitis. Dig Endosc 2016; 28: 33-41
    CrossrefPubMedSuche in Google Scholar
  • 19 Aiolfi A, Bona D, Riva CG. et al. Systematic review and Bayesian network meta-analysis comparing laparoscopic Heller myotomy, pneumatic dilatation, and peroral endoscopic myotomy for esophageal achalasia. J Laparoendosc Adv Surg Tech A 2020; 30: 147-155
    CrossrefPubMedSuche in Google Scholar
  • 20 Shiwaku H, Inoue H, Onimaru M. et al. Multicenter collaborative retrospective evaluation of peroral endoscopic myotomy for esophageal achalasia: analysis of data from more than 1300 patients at eight facilities in Japan. Surg Endosc 2020; 34: 464-468
    CrossrefPubMedSuche in Google Scholar
  • 21 Sanaka MR, Thota PN, Parikh MP. et al. Peroral endoscopic myotomy leads to higher rates of abnormal esophageal acid exposure than laparoscopic Heller myotomy in achalasia. Surg Endosc 2019; 33: 2284-2292
    CrossrefPubMedSuche in Google Scholar
  • 22 Bechara R, Inoue H, Shimamura Y. et al. Gastroesophageal reflux disease after peroral endoscopic myotomy: lest we forget what we already know. Dis Esophagus 2019; 32: doz106
    CrossrefPubMedSuche in Google Scholar
  • 23 Kahrilas PJ, Katzka D, Richter JE. Clinical practice update: the use of per-oral endoscopic myotomy in achalasia: expert review and best practice advice from the AGA Institute. Gastroenterology 2017; 153: 1205-1211
    CrossrefPubMedSuche in Google Scholar
  • 24 Inoue H, Ueno A, Shimamura Y. et al. Peroral endoscopic myotomy and fundoplication: a novel NOTES procedure. Endoscopy 2019; 51: 161-164
    Thieme ConnectPubMedSuche in Google Scholar
  • 25 Toshimori A, Inoue H, Shimamura Y. et al. Peroral endoscopic fundoplication: a brand-new intervention for GERD. VideoGIE 2020; 5: 244-246
    CrossrefPubMedSuche in Google Scholar
  • 26 Bapaye A, Dharamsi S, Jain R. et al. Concomitant endoscopic fundoplication – can it reduce the risk of gastroesophageal reflux following peroral endoscopic myotomy?. Endoscopy 2020; 52: E73-E74
    Thieme ConnectPubMedSuche in Google Scholar
  • 27 Gyawali CP, Kahrilas PJ, Savarino E. et al. Modern diagnosis of GERD: the Lyon Consensus. Gut 2018; 67: 1351-1362
    CrossrefPubMedSuche in Google Scholar
  • 28 Jones R, Junghard O, Dent J. et al. Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther 2009; 30: 1030-1038
    CrossrefPubMedSuche in Google Scholar
  • 29 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
    CrossrefPubMedSuche in Google Scholar
  • 30 Wang HY, Leena KB, Plymoth A. et al. Prevalence of gastroesophageal reflux disease and its risk factors in a community-based population in southern India. BMC Gastroenterol 2016; 16: 36
    CrossrefPubMedSuche in Google Scholar
  • 31 Ichkhanian Y, Benias P, Khashab M. Case of early Barrett cancer following peroral endoscopic myotomy. Gut 2019; 68: 2107-2110
    CrossrefPubMedSuche in Google Scholar
  • 32 Moonen A, Annese V, Belmans A. et al. Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut 2016; 65: 732-739
    CrossrefPubMedSuche in Google Scholar
  • 33 Rawlings A, Soper NJ, Oelschlager B. et al. Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc 2012; 26: 18-26
    CrossrefPubMedSuche in Google Scholar
  • 34 Inoue H, Shiwaku H, Kobayashi Y. et al. Statement for gastroesophageal reflux disease after peroral endoscopic myotomy from an international multicenter experience. Esophagus 2020; 17: 3-10
    CrossrefPubMedSuche in Google Scholar
  • 35 Tyberg A, Choi A, Gaidhane M. et al. Transoral incisional fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal. Endosc Int Open 2018; 6: E549-E552
    Thieme ConnectPubMedSuche in Google Scholar
  • 36 Brewer Gutierrez OI, Benias PC, Khashab MA. Same-session per-oral endoscopic myotomy followed by transoral incisionless fundoplication in achalasia: are we there yet?. Am J Gastroenterol 2020; 115: 162
    CrossrefPubMedSuche in Google Scholar