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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(10): E1491-E1496
DOI: 10.1055/a-1520-0016
Original article

Changes in weight following peroral endoscopic myotomy: results from a North American center

Simon Hew
1   Monash Medical Centre Clayton, Gastroenterology and Hepatology, Clayton, VIC, AUS
2   Queen’s University, Department of Medicine, Kingston, ON, CAN
,
Douglas Motomura
2   Queen’s University, Department of Medicine, Kingston, ON, CAN
,
Robert Bechara
2   Queen’s University, Department of Medicine, Kingston, ON, CAN
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Abstract

Background and study aims Weight loss is a feature of untreated achalasia. While weight gain after achalasia treatment is expected, little data exist about the extent of it, particularly after peroral endoscopic myotomy (POEM). We aimed to describe the changes in weight after POEM.

Patients and methods A retrospective analysis was performed of patients from March 2016 to March 2020 undergoing POEM by an experienced operator at an academic referral center in Kingston, Ontario, Canada. Data examined included pre- and post-POEM body mass index (BMI), procedural characteristics, and Eckardt scores.

Results Ninety-two patients underwent POEM during the study period, for 77 of whom follow-up data were available including BMI. Prior to POEM, the median BMI was 26. Six patients (7.8 %) were considered to be underweight, 24 (31.2 %) were normal, 26 (33.8 %) were pre-obese, and 21 (27.2 %) were obese. At a median follow-up of 15 months, the clinical success rate was 95 %. Patients in the normal weight and pre-obesity categories had a significant increase in weight post-POEM. Of the underweight patients, two (33.3 %) moved up to a normal weight category and two (33.3 %) became pre-obese. In the normal BMI category, eight (37.5 %) became pre-obese and one patient (4.2 %) became obese. Ten of the 26 pre-obese patients (38.4 %) were obese post-POEM. Seven of the obese patients (33.3 %) reached Class III (morbid) obesity at follow-up. 

Conclusions Patients may experience a marked increase in BMI following POEM, with over one-third of patients becoming pre-obese, obese or morbidly obese at follow-up in our study in a North American population. Further study is required to analyze weight gain patterns post-POEM.



Publication History

Received: 09 December 2020

Accepted: 19 May 2021

Article published online:
16 September 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Sadowski DC, Ackah F, Jiang B. et al. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastro Motil 2010; 22: 256-261
    CrossrefPubMedGoogle Scholar
  • 2 Inoue H, Minami H, Kobayashi Y. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Akintoye E, Kumar N, Obaitan I. et al. Peroral endoscopic myotomy: a meta-analysis. Endoscopy 2016; 48: 1059-1068
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Li Q, Wu Q, Zhang X. et al. Outcomes of per-oral endoscopic myotomy for treatment of esophageal achalasia with a median follow-up of 49 months. Gastrointest Endosc 2018; 87: 1405-1412
    CrossrefPubMedGoogle Scholar
  • 5 Newberry C, Vajravelu RK, Pickett-Blakely O. et al. Achalasia patients are at nutritional risk regardless of presenting weight category. Dig Dis Sci 2018; 63: 1243-1249
    CrossrefPubMedGoogle Scholar
  • 6 Kahrilas PJ, Bredenoord A, Fox M. et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastro Motil 2015; 27: 160-174
    CrossrefPubMedGoogle Scholar
  • 7 Eckardt VF. Clinical presentations and complications of achalasia. Gastrointest Endosc 2001; 11: 281-292
    PubMedGoogle Scholar
  • 8 Prakash Gyawali C, Kahrilas P, Savarino E. et al. Modern diagnosis of GERD: The Lyon Consensus. Gut 2018; 67: 1351-1362
    CrossrefPubMedGoogle Scholar
  • 9 Mizusawa T, Sato H, Kamimura K. et al. Change in body composition in patients with achalasia before and after peroral endoscopic myotomy. J Gastroenterol Hepatol 2020; 35: 601-608
    CrossrefPubMedGoogle Scholar
  • 10 Calle EE, Thun MJ, Petrelli JM. et al. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999; 341: 1097-1105
    CrossrefPubMedGoogle Scholar
  • 11 Steele CB, Thomas C, Henley S. et al. Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity – United States, 2005-2014. MMWR. Morb Mortal Wkly Rep 2017; 66: 1052-1058
    CrossrefPubMedGoogle Scholar