Gastroesophageal reflux disease after peroral endoscopic myotomy: Short-term, medium-term, and long-term results.

Abstract

INTRODUCTION AND AIMS:

Achalasia is characterized by incomplete relaxation of the lower esophageal sphincter and esophageal aperistalsis. The efficacy of peroral endoscopic myotomy (POEM) is similar to that of the Heller myotomy, with an apparently greater prevalence of gastroesophageal reflux disease. Our aim was to determine the presence of GERD in a post-POEM cohort of Mexican patients with achalasia and follow-up of at least 12 months.

MATERIALS AND METHODS:

A retrospective cohort study was conducted on post-POEM patients with a minimum of 12 months of follow-up, within the time frame of 2012 to 2017. Pregnant patients were excluded. Serial endoscopy, pH study, and GERDQ application were performed. Univariate and bivariate data analyses were carried out and statistical significance was set at a P<0.05.

RESULTS:

Sixty-eight patients had post-POEM follow-up for 12 months. Of those patients, follow-up continued to 24 months for 58, 36 months for 47, 48 months for 39, and 60 months for 25. Mean patient age was 47.8±14.3 years, 57.3% of the patients were women, 77.9% were treatment-naïve, and 54.4% had type II achalasia. The pH study, endoscopy, and questionnaire were positive in 73, 28, and 18% at 3 months; 48, 35, and 13% at 6 months, and 55, 30, and 15% at 12 months, respectively. Once the proton pump inhibitor was begun, the percentages decreased to 5, 2, and 6% at 24 months; 6, 2, and 8% at 36 months; 4,1, and 6% at 48 months; and 3, 1, and 4% at 60 months, respectively. There was no relation between the efficacy of POEM and the presence or intensity of GERD. There were no secondary complications due to gastroesophageal reflux.

CONCLUSIONS:

The post-POEM prevalence of GERD was 50% in the short term (12 months), with no evidence of complications at the medium term or long term (60 months). Gastroesophageal reflux was adequately controlled through proton pump inhibitors administration in over 95% of the cases.

• Authors: O V Hernández-Mondragón, O M Solórzano-Pineda, M González-Martínez, J M Blancas-Valencia
• Journal: Revista de gastroenterologia de Mexico (English) (Rev Gastroenterol Mex (Engl Ed)) 2020 Jan - Mar Vol. 85 Issue 1 Pg. 4-11 ISSN: 2255-534X [Electronic] Mexico
• Vernacular Title: Enfermedad por reflujo gastroesofágico posterior a miotomía endoscópica a través de la boca: Resultados a corto, mediano y largo plazo.
• PMID: 31174905 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

Chemical References

• Proton Pump Inhibitors

Topics

• Adult
• Aged
• Esophageal Achalasia (surgery)
• Female
• Follow-Up Studies
• Gastroesophageal Reflux (drug therapy, epidemiology, etiology)
• Humans
• Male
• Middle Aged
• Postoperative Complications (drug therapy, epidemiology)
• Prevalence
• Proton Pump Inhibitors (therapeutic use)
• Pyloromyotomy
• Retrospective Studies
• Treatment Outcome