Management of achalasia cardia: Expert consensus statements

Ramchandani, Mohan; Reddy, D. Nageshwar; Nabi, Zaheer; Chavan, Radhika; Bapaye, Amol; Bhatia, Shobna; Mehta, Nilay; Dhawan, Pankaj; Chaudhary, Adarsh; Ghoshal, Uday C; Philip, Mathew; Neuhaus, Horst; Devière, Jacques; Inoue, Haruhiro

doi:10.1111/jgh.14097

Cited by 34 publications

(23 citation statements)

References 124 publications

(309 reference statements)

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“…The study published in 2018 by Teitelbaum et al also showed a decrease in the clinical success rate ▶ of POEM in Achalasia patients to around 83 % at 5 years followup. This has been traditionally explained by the degenerative nature of Achalasia and the fact that all available treatments are rather palliative than curative [24]. On the other hand, Hungness et al reported the durability of POEM after following 115 patients for an average of 2.4 years post-POEM, showing a stable clinical success rate of 92 %.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study

et al. 2020

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Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clinical response of 82 % to 100 % in treatment of patients with achalasia. Data are limited on the long-term durability of the clinical response in these patients. The aim of this study was to determine the long-term outcomes of patients undergoing POEM for management of achalasia. Methods This was a retrospective multicenter cohort study of consecutive patients who underwent POEM for management of achalasia. Patients had a minimum of 4 years follow-up. Clinical response was defined by an Eckardt score ≤ 3. Results A total of 146 patients were included from 11 academic medical centers. Mean (± SD) age was 49.8 (± 16) years and 79 (54 %) were female. The most common type of achalasia was type II, seen in 70 (47.9 %) patients, followed by type I seen in 41 (28.1 %) patients. Prior treatments included: pneumatic dilation in 29 (19.9 %), botulinum toxin injection in 13 (8.9 %) and Heller myotomy in seven patients (4.8 %). Eight adverse events occurred (6 mucosotomies, 2 pneumothorax) in eight patients (5.5 %). Median follow-up duration was 55 months (IQR 49.9–60.6). Clinical response was observed in 139 (95.2 %) patients at follow-up of ≥ 48 months. Symptomatic reflux after POEM was seen in 45 (32.1 %) patients, while 35.3 % of patients were using daily PPI at 48 months post POEM. Reflux esophagitis was noted in 16.8 % of patients who underwent endoscopy. Conclusion POEM is a durable and safe procedure with an acceptably low adverse event rate and an excellent long-term clinical response.

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Section: Discussionmentioning

confidence: 99%

Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study

et al. 2020

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“…Peroral endoscopic myotomy (POEM): a comparative study between Chagasic and idiopathic achalasia Esophagogastroduodenoscopy (EGD) and the barium esophagogram are auxiliary tests. Endoscopic, pharmacological or surgical options are available for treatment of achalasia [9,10]. Currently, laparoscopic Heller myotomy (LHM) is considered the standard surgical method.…”

Section: Introductionmentioning

confidence: 99%

“…Currently, laparoscopic Heller myotomy (LHM) is considered the standard surgical method. However, in recent years, peroral endoscopic myotomy (POEM) has gained popularity due to its excellent safety and efficacy profile [8,9].…”

Section: Introductionmentioning

confidence: 99%

Peroral endoscopic myotomy (POEM): a comparative study between Chagasic and idiopathic achalasia

et al. 2020

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Background and study aims Achalasia can be classified as either primary (idiopathic) achalasia or secondary achalasia, which is a consequence of another systemic disease. Peroral endoscopic myotomy (POEM) is an effective and safe treatment for achalasia. We evaluated the efficacy and safety of POEM in patients with Chagasic achalasia compared to idiopathic achalasia. Patients and methods We evaluated POEM procedures performed at a single institution from November 2016 to January 2018. Demographic data, Eckardt score, lower esophageal sphincter (LES) pressure, body mass index, post-operative erosive esophagitis, adverse events, length of hospital stay, and procedure-related parameters were analyzed. Results Fifty-one patients underwent POEM as a treatment for achalasia in this period (20 patients with Chagasic and 31 with Idiopathic etiology). The overall clinical success rate was 92.1 %, with no statistical difference between groups (90 % in the Chagasic group vs. 93.5 % in the Idiopathic group, P = 0.640). Both groups had significant reduction in Eckardt score and in LES pressure, and increase in bodey mass index (BMI) at 1-year follow-up. There was no statistical difference between groups regarding Eckardt score (P = 0.439), LES pressure (p = 0.507), BMI (P = 0.254), post erosive esophagitis (35 % vs. 38.7 %, P = 0.789), adverse events (30 % vs. 12 %, P = 0.163,) length of hospital stay (3.75 days vs. 3.58 days, P = 0.622), and operative time (101.3 min vs. 99.1 min, P = 0.840). Conclusion POEM is an effective and safe treatment for patients with achalasia. There is no difference in POEM outcomes for those patients with Chagasic or Idiopathic achalasia.

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“…POEM is a suitable procedure for naïve patients, patients with a prior treatment failure as well as for patients with sigmoid-type achalasia (although a skilled endoscopist is required) due to its safety and efficacy. Patients with end-stage achalasia (tortuous or sigmoid esophagus type II, classified based on computed tomography) may require esophagectomy [13].…”

Section: Discussionmentioning

confidence: 99%

“…The questions asked in the medical interview include changes in the amount of meals consumed and changes in body weight after the procedure, compared to before the procedure. Esophageal symptoms such as dysphagia and chest pain were also included in the interview and can be measured by Eckardt scores [13]. The opening of the esophagogastric junction by gastrointestinal endoscopy should also be evaluated and compared with pre-POEM.…”

Section: Discussionmentioning

confidence: 99%

Peroral Endoscopic Myotomy in a Patient with Achalasia Cardia with Prior Heller’s Myotomy

Miftahussurur

Tandan

Makmun

et al. 2020

Case Rep Gastroenterol

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Achalasia cardia is an esophageal myenteric plexus disorder characterized by absence of or incomplete lower esophageal sphincter relaxation and esophageal aperistalsis; Heller's myotomy is the main treatment of choice due to a lower failure rate. Recently, peroral endoscopic myotomy (POEM) has been reported as an alternative treatment for achalasia due to persistent symptoms after Heller's myotomy. An Indian male, aged 18 years, was admitted to the hospital due to dysphagia which had started more than 3 years ago. He also complained of occasional regurgitation and retrosternal pain with Eckardt score 6. Heller's myotomy was performed 2 years ago. Barium swallow showed achalasia cardia and upper gastrointestinal endoscopy found liquid residue and resistance at the gastroesophageal junction. Esophageal manometry is concluded as achalasia cardia type II with a median integrated relaxation pressure (IRP) of 25.6 mm Hg. He underwent POEM; with the help of a submucosal tunnel, an extension of up to 1 cm beyond the gastroesophageal junction could be achieved with a posterior orientation of myotomy. There were no adverse events after the POEM procedure. He was treated with a soft diet for 10 days and other supportive treatments. Following POEM, barium swallow Case 49 showed a significant improvement and esophageal manometry exhibited that the basal lower esophageal sphincter pressure was normal with complete relaxation on swallowing and normal median IRP. The post-procedure Eckardt score was 0. We reported an achalasia patient who received POEM after unsuccessful Heller's myotomy and showed clinical improvement.

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Management of achalasia cardia: Expert consensus statements

Cited by 34 publications

References 124 publications

Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study

Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study

Peroral endoscopic myotomy (POEM): a comparative study between Chagasic and idiopathic achalasia

Peroral Endoscopic Myotomy in a Patient with Achalasia Cardia with Prior Heller’s Myotomy

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