BACKGROUND:

Per-oral endoscopic myotomy (POEM) has shown promising safety and efficacy in short-term studies. However, long term follow-up data is very limited. The aims of this study were to assess (1) clinical outcome of patients with a minimum post-POEM follow-up of 2 years and (2) factors associated with long term clinical failure after POEM.

METHODS:

A retrospective chart review was performed that included all consecutive patients with achalasia who underwent POEM with a minimum follow-up of 2 years at 10 tertiary-care centers. Clinical response was defined by decrease in Eckardt score to 3 or lower.

RESULTS:

A total of 205 patients (45.8% men; mean age 49 years) were followed for a median of 31 months (interquartile range 26 - 38). Of these, 81 patients (39.5%) had received previous treatment for achalasia before POEM. Clinical success was achieved in 98% (185/189), 98% (142/144), and 91% (187/205) in patients with follow-up within 6 months, at 12 months, and ≥24 months, respectively. Of 185 patients with clinical response at 6 months, 11 (6%) experienced recurrent symptoms at 2 years. History of prior pneumatic dilation was associated with long-term treatment failure (OR, 3.41; 95% CI, 1.25 - 9.23). Procedure-related adverse events occurred in 8.2% of patients and only one patient required surgical intervention. Abnormal esophageal acid exposure and reflux esophagitis were documented in 37.5% and 18% of patients, respectively. However, these rates are of simply a reference number among very selective group of patients.

CONCLUSION:

POEM is safe and provides high initial clinical success and excellent long-term outcomes. Among patients who were confirmed clinical response within 6 months, 6% had recurrent symptoms by 2 years.

Le POEM est une technique sûre et efficace qui devrait remplacer à terme la chirurgie ; reste à bien définir sa place par rapport à la dilatation pneumatique, standard actuel de première intention.