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Long-term efficacy of peroral endoscopic myotomy for achalasia under different criteria

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Abstract

Background

Peroral endoscopic myotomy (POEM) has emerged as a widely accepted treatment for achalasia, with limited studies for over 2 years. Additionally, traditional measurements of achalasia after POEM have deficiencies. The study aimed to analyze the long-term outcomes of POEM under different criteria.

Methods

Patients with achalasia who received POEM between November 2012 and March 2021 were recruited. Patients and characteristics were shown, and risk factors related to two novel definitions of recurrence, symptomatic reflux, and reflux esophagitis were analyzed.

Results

Three hundred and twenty-one patients were included. At a median follow-up of 52 months, twenty-three failures happened (7.17%) under the modified criterion, and forty-seven failures occurred (14.64%) under the normal standard. Hospitalization (P = 0.027) and esophageal myotomy length (P = 0.039) were significantly associated with long-term efficacy under the modified and normal criteria, respectively. Fifty-two patients (16.20%) reported reflux symptoms and endoscopy performed in 88 patients revealed reflux esophagitis in 22 cases (25.00%). There were no predictors in the analysis of symptomatic reflux and gender (P = 0.010), LESP (P = 0.013), IRP (P = 0.015), and the esophageal myotomy length (P = 0.032) were statistically related to reflux esophagitis.

Conclusion

POEM is an extremely safe and effective treatment for achalasia with long-term follow-up. Shorter hospitalization and shorter esophageal myotomy length may decrease the incidence of recurrence under the modified and normal criteria, respectively. Long-term outcomes of POEM are unpredictable. No risk factors were related to symptomatic reflux, and male patients with low preoperative LESP and IRP needed relatively shorter esophageal myotomy to prevent reflux esophagitis.

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Acknowledgements

We would like to thank the contributions of the participants in the study and the First Affiliated Hospital of Nanjing Medical University staff.

Funding

The article was supported by National Natural Science Foundation of China (Grant No. 82200625). The funding has no conflicts of interest with this article or all the authors.

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Author notes

  1. Zhouyao Qian, Haisheng Qian, Xin Gao, Zhen Yang, and Yun Wang have contributed equally.

Authors and Affiliations

  1. Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China

    Zhouyao Qian, Haisheng Qian, Xin Gao, Yun Wang, Xueliang Li, Weifeng Zhang, Guoxin Zhang & Xuan Li

  2. Department of Gastroenterology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu, China

    Zhen Yang

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  1. Zhouyao Qian
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Contributions

ZQ, HQ, XL and GZ contributed to the design of the study. ZQ, XG and ZY contributed to the data collection. ZQ, HQ and XL contributed to the statistical analysis. ZQ, HQ, XL and GZ contributed to make diagrams and finish manuscript. YW, XL, WZ, GZ and XL contributed to the operations. All authors read and approved the final version of the manuscript. ZQ, HQ, XG, ZY and YW were the first authors. XL and GZ were the corresponding authors.

Corresponding authors

Correspondence to Guoxin Zhang or Xuan Li.

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Zhouyao Qian, Haisheng Qian, Xin Gao, Zhen Yang, Yun Wang, Xueliang Li, Weifeng Zhang, Guoxin Zhang and Xuan Li have no conflicts of interest or financial ties to disclose.

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Qian, Z., Qian, H., Gao, X. et al. Long-term efficacy of peroral endoscopic myotomy for achalasia under different criteria. Surg Endosc (2024). https://doi.org/10.1007/s00464-024-10742-w

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