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Early outcomes of peroral endoscopic myotomy with fundoplication for achalasia cardia – Is it here to stay?
Author(s) -
Patil Gaurav,
Dalal Ankit,
Maydeo Amit
Publication year - 2021
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.13796
Subject(s) - medicine , achalasia , myotomy , surgery , endoscope , gerd , dysphagia , heller myotomy , subcutaneous emphysema , endoscopy , esophagus , reflux , complication , disease
Background Peroral endoscopic myotomy with fundoplication (POEM‐F) has garnered widespread attention since it tries to achieve an appropriate antireflux procedure during the same setting. The outcomes of POEM‐F are currently unexplored. Methods Patients who underwent POEM‐F at our center were retrospectively studied to assess its safety and early outcomes. Results Twenty patients [70% male; median age 32 years (range 25–41)], with a median symptom duration of 2.1 years (range 1.5–3.7) with achalasia were included. POEM‐F procedure was completed in a median of 118 min (range 90–160), with 17/20 (85%) technical success. The median hospitalization was 4 days (range 2–7). Capnothorax ( n = 3), resolved spontaneously ( n = 2) in 4–6 h, while in one patient ( n = 1) the endoscope inadvertently entered into the thoracic cavity for which prophylactic intercostal drain was required. Capnoperitoneum was seen in 17/17 (100%) patients who underwent fundoplication, subcutaneous emphysema in 8/17 (47%) patients. At 1‐month follow‐up endoscopy, 5/17 (29.4%) patients had loosening of the fundal wrap, 3/17 (17.6%) patients had ulceration in fundus and in gastroesophageal junction due to underlying hemoclips. At 3 months, loosening of the fundal wrap was seen in 7/17 (41.2%) patients. A 24‐h pH‐metry revealed abnormal esophageal acid exposure in 7/17 (41.2%) patients, while it was normal in those patients in whom the fundal wrap was maintained. 10/17 (58.8%) patients were off proton pump inhibitors. Conclusion POEM‐F is technically feasible with reasonable short term success. However, the durability, early success and safety of POEM‐F need reassessment in long‐term studies before being applied in clinical practice.