Gastroesophageal reflux after per oral endoscopic myotomy for achalasia: Results of a monocentric cohort - 22/08/24
Highlights |
• | The present study shows a low prevalence of severe esophagitis (4 %) at short-term follow-up. Furthermore, in those individuals that underwent subsequent endoscopies, the rate of erosive esophagitis remained low. |
• | Our retrospective study on GERD after POEM for achalasia confirms the recent literature on the subject: severe reflux esophagitis is rare, GERD symptoms are usually mild, and easily controlled by PPI in the majority. |
• | The symptoms are poorly correlated with the severity of reflux, an UGI endoscopic monitoring after POEM seems advisable to detect GERD mucosal complications, and then guide the subsequent steps in the overall care. |
• | Prospective high-quality studies seem necessary to determine the best methods to monitor GERD after POEM for achalasia. |
Abstract |
Background and study aims |
Peroral endoscopic myotomy (POEM) has become the first line treatment for achalasia, but controversies remain about the prevalence of gastro-esophageal reflux disease (GERD) after the procedure. The aim of this study was to evaluate post-POEM GERD by a retrospective analysis of a single center cohort.
Patients and methods |
Achalasia patients aged 18 or above, who underwent POEM between 2012 and 2021, were included, provided they had an endoscopic control of reflux at least one year after POEM. GERD symptoms based on GerdQ questionnaire, and proton pomp inhibitors (PPI) consumption were also evaluated.
Results |
Among a consecutive cohort of 422 patients treated by POEM, 254 patients were included. Endoscopic results were available after a mean follow-up of 1.9 ± 1.5 years. 71/254 patients (28 %) had erosive esophagitis (86 % Los Angeles Grade A or B). At the last follow-up (mean 4.5 ± 2.2 years), clinical success of POEM (Eckardt score ≤ 3) was achieved in 79.5 % of patients. 44.5 % of patients were on PPI. Mean GerdQ score was 2.2 ± 2.7, with only 13 patients (6.5 %) with a score ≥ 8.
Conclusion |
In this cohort of achalasia patients with an endoscopic follow-up at least 1 year after POEM, GERD did not appear a major threat concern: clinical symptoms were mild in most cases, as was the degree of erosive esophagitis. Furthermore, at the time of last follow up, less than half of patients required treatment with PPI.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Gastro-esophageal reflux, Esophagitis, Per-oral endoscopic myotomy, Achalasia
Abbreviations : AET, EGJ, FU, GERD, GI, HRM, LA, LHM, PEP, POEM, PPI
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Vol 48 - N° 8
Articolo 102440- Ottobre 2024 Ritorno al numero
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