Management of patients after failed peroral endoscopic myotomy: a multicenter study

Yervant Ichkhanian; Daniella Assis; Pietro Familiari; Michael Ujiki; Baily Su; Sarah R. Khan; Mathieu Pioche; Peter V. Draganov; Joo young Cho; Nikolas Eleftheriadis; Maximilien Barret; Amyn Haji; Vic Velanovich; Marcel Tantau; Jeffrey M. Marks; Amol Bapaye; Alireza Sedarat; Eduardo Albeniz; Robert Bechara; Nikhil A. Kumta; Guido Costamagna; Yaseen B. Perbtani; Mehul Patel; Megan Sippey; Sravan K. Korrapati; Rishabh Jain; Fermín Estremera; Mohamad H. El Zein; Olaya I. Brewer Gutierrez; Mouen A. Khashab

doi:10.1055/a-1312-0496

Endoscopy, Table of Contents

Endoscopy 2021; 53(10): 1003-1010
DOI: 10.1055/a-1312-0496

Original article

Management of patients after failed peroral endoscopic myotomy: a multicenter study

Yervant Ichkhanian^*

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

,

Daniella Assis^*

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

,

Pietro Familiari

²Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Michael Ujiki

³Department of Surgery, Northshore University Health System, Chicago, Illinois, USA

,

Baily Su

⁴Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA

,

Sarah R. Khan

⁵Department of Medicine, Saint Agnes Hospital, Baltimore, Maryland, USA

,

Mathieu Pioche

⁶Department of Endoscopy and Gastroenterology, Pavillon L Edouard Herriot Hospital, Lyon, France

,

Peter V. Draganov

⁷University of Florida, Gainesville, Florida, USA

,

Joo young Cho

⁸CHA Bundang Medical Center, Seongnam, Republic of Korea

,

Nikolas Eleftheriadis

⁹Euromedica Kyanous Stauros, Thessaloniki, Greece

,

Maximilien Barret

¹⁰Cochin Hospital, Paris, France

,

Amyn Haji

¹¹King's College NHS Foundation Trust, London, UK

,

Vic Velanovich

¹²University of South Florida, Tampa, Florida, USA

,

Marcel Tantau

¹³Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania

,

Jeffrey M. Marks

¹⁴University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA

,

Amol Bapaye

¹⁵Deenanath Mangeshkar Hospital, Pune, India

,

Alireza Sedarat

¹⁶UCLA School of Medicine, Los Angeles, California, USA

,

Eduardo Albeniz

¹⁷Gastroenterology Department, Complejo Hospitalario de Navarra, Navarro, Spain

,

Robert Bechara

¹⁸Queen's University, Kingston, Ontario, Canada

,

Nikhil A. Kumta

¹⁹Icahn School of Medicine at Mount Sinai, New York, New York, USA

,

Guido Costamagna

²Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Yaseen B. Perbtani

⁷University of Florida, Gainesville, Florida, USA

,

Mehul Patel

¹¹King's College NHS Foundation Trust, London, UK

,

Megan Sippey

¹⁴University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA

,

Sravan K. Korrapati

¹⁵Deenanath Mangeshkar Hospital, Pune, India

,

Rishabh Jain

¹⁵Deenanath Mangeshkar Hospital, Pune, India

,

Fermín Estremera

¹⁷Gastroenterology Department, Complejo Hospitalario de Navarra, Navarro, Spain

,

Mohamad H. El Zein

²⁰Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, USA

,

Olaya I. Brewer Gutierrez

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

,

Mouen A. Khashab

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

› Author Affiliations

Abstract

Background Although peroral endoscopic myotomy (POEM) is highly effective for the management of achalasia, clinical failures may occur. The optimal management of patients who fail POEM is not well known. This study aimed to compare the outcomes of different management strategies in patients who had failed POEM.

Methods This was an international multicenter retrospective study at 16 tertiary centers between January 2012 and November 2019. All patients who underwent POEM and experienced persistent or recurrent symptoms (Eckardt score > 3) were included. The primary outcome was to compare the rates of clinical success (Eckardt score ≤ 3) between different management strategies.

Results 99 patients (50 men [50.5 %]; mean age 51.4 [standard deviation (SD) 16.2]) experienced clinical failure during the study period, with a mean (SD) Eckardt score of 5.4 (0.3). A total of 29 patients (32.2 %) were managed conservatively and 70 (71 %) underwent retreatment (repeat POEM 33 [33 %], pneumatic dilation 30 [30 %], and laparoscopic Heller myotomy (LHM) 7 [7.1 %]). During a median follow-up of 10 (interquartile range 3 – 20) months, clinical success was highest in patients who underwent repeat POEM (25 /33 [76 %]; mean [SD] Eckardt score 2.1 [2.1]), followed by pneumatic dilation (18/30 [60 %]; Eckardt score 2.8 [2.3]), and LHM (2/7 [29 %]; Eckardt score 4 [1.8]; P = 0.12). A total of 11 patients in the conservative group (37.9 %; mean Eckardt score 4 [1.8]) achieved clinical success.

Conclusion This study comprehensively assessed an international cohort of patients who underwent management of failed POEM. Repeat POEM and pneumatic dilation achieved acceptable clinical success, with excellent safety profiles.

Full Text

References

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Supplementary Material

Supplementary material