Gastrointestinal endoscopy · 2025
Long-term (3-year) composite gastroesophageal reflux outcomes of peroral endoscopic myotomy with or without concomitant endoscopic fundoplication in matched cohorts of achalasia.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Bapaye Amol, Yewale Rohan, Shah Jimil, Bale R Ajay, Ansari Jaseem, Borkar Mangesh, Bapaye Harsh, Pujari Rajendra, Gadhikar Harshal
Аннотация
BACKGROUND AND AIMS: Peroral endoscopic myotomy (POEM) is well established for the treatment of achalasia. Post-POEM gastroesophageal reflux (GER) has been identified as a concern. Concomitant endoscopic fundoplication (POEM + F) may reduce post-POEM GER. This study compares composite (objective and subjective) GER outcomes at 3 years' follow-up in a matched cohort of patients with achalasia undergoing POEM versus POEM + F.
METHODS: This single-center, retrospective, matched cohort study compared POEM + F versus POEM. It used retrospective matching with criteria as follows: age, sex, body mass index, achalasia type, prior interventions, and American Society of Anesthesiologists status. Baseline characteristics, pre/postprocedure Eckardt scores (ESs), technical aspects, and AEs were recorded. Both groups were followed up annually for 3 years. Outcomes were compared at 3 years. The primary outcome was the incidence of objective GER (Lyon Consensus 2.0); and secondary outcomes were subjective (symptomatic) GER (GERD questionnaire, Reflux Symptom Index, GERD health-related quality of life), and clinical success (ES <3). P < .05 was considered significant.
RESULTS: Thirty-four POEM + F patients were matched to 34 POEM patients (total consecutive POEM + F = 41; excluded = 7 [technical failure, = 2; unsuitable match, = 5]). AEs included mucosal injury (POEM vs POEM-F, 11.8% vs 8.8%; P = .69). One recurrence (POEM + F) at 9 months was excluded for long-term follow-up. At the 3-year follow-up, objective GER (esophageal acid exposure time >6% and/or Grade B or higher esophagitis) was observed in 2 (13.3%) of 15 patients (POEM + F) versus 7 (58.3%) of 12 (POEM) (P = .037). Wrap integrity was maintained in 76.5% of POEM + F cases at 3 years. Symptomatic GER (symptom scores) was low and comparable in both groups. Clinical success (ES <3) was sustained in all except 1 patient with recurrence (98.5%).
CONCLUSIONS: In a retrospective matched cohort, GER was significantly less frequent after POEM + F than only POEM, and wrap integrity was maintained in three-fourths of patients at the 3-year follow-up.
METHODS: This single-center, retrospective, matched cohort study compared POEM + F versus POEM. It used retrospective matching with criteria as follows: age, sex, body mass index, achalasia type, prior interventions, and American Society of Anesthesiologists status. Baseline characteristics, pre/postprocedure Eckardt scores (ESs), technical aspects, and AEs were recorded. Both groups were followed up annually for 3 years. Outcomes were compared at 3 years. The primary outcome was the incidence of objective GER (Lyon Consensus 2.0); and secondary outcomes were subjective (symptomatic) GER (GERD questionnaire, Reflux Symptom Index, GERD health-related quality of life), and clinical success (ES <3). P < .05 was considered significant.
RESULTS: Thirty-four POEM + F patients were matched to 34 POEM patients (total consecutive POEM + F = 41; excluded = 7 [technical failure, = 2; unsuitable match, = 5]). AEs included mucosal injury (POEM vs POEM-F, 11.8% vs 8.8%; P = .69). One recurrence (POEM + F) at 9 months was excluded for long-term follow-up. At the 3-year follow-up, objective GER (esophageal acid exposure time >6% and/or Grade B or higher esophagitis) was observed in 2 (13.3%) of 15 patients (POEM + F) versus 7 (58.3%) of 12 (POEM) (P = .037). Wrap integrity was maintained in 76.5% of POEM + F cases at 3 years. Symptomatic GER (symptom scores) was low and comparable in both groups. Clinical success (ES <3) was sustained in all except 1 patient with recurrence (98.5%).
CONCLUSIONS: In a retrospective matched cohort, GER was significantly less frequent after POEM + F than only POEM, and wrap integrity was maintained in three-fourths of patients at the 3-year follow-up.