Prediction, prevention and management of gastroesophageal reflux after per-oral endoscopic myotomy: An update

Abstract

Achalasia cardia, the most prevalent primary esophageal motility disorder, is predominantly characterized by symptoms of dysphagia and regurgitation. The principal therapeutic approaches for achalasia encompass pneumatic dilatation (PD), Heller's myotomy, and the more recent per-oral endoscopic myotomy (POEM). POEM has been substantiated as a safe and efficacious modality for the management of achalasia. Although POEM demonstrates superior efficacy compared to PD and an efficacy parallel to Heller's myotomy, the incidence of gastroesophageal reflux disease (GERD) following POEM is notably higher than with the aforementioned techniques. While symptomatic reflux post-POEM is relatively infrequent, the significant occurrence of erosive esophagitis and heightened esophageal acid exposure necessitates vigilant monitoring to preclude long-term GERD-related complications. Contemporary advancements in the field have enhanced our comprehension of the risk factors, diagnostic methodologies, preventative strategies, and therapeutic management of GERD subsequent to POEM. This review focuses on the limitations inherent in the 24-h pH study for evaluating post-POEM reflux, potential modifications in the POEM technique to mitigate GERD risk, and the strategies for managing reflux following POEM.

Gastroesophageal reflux after per-oral endoscopic myotomy: Management literature

“…In the Nabi et al [ 34 ] review article titled “Prediction, prevention, and management of gastroesophageal reflux after per-oral endoscopic myotomy: An update” and published in the World Journal of Gastroenterology , the authors provided a well-organized, comprehensive review of post-POEM GER in terms of risk factors, diagnosis, prevention, and management. They provided an algorithm for the evaluation and management of post-POEM GER.…”

Gastroesophageal reflux following per-oral endoscopic myotomy: Can we improve outcomes?

“…However, the ‘Achilles heel’ of the procedure is the occurrence of Gastro Esophageal Reflux disease (GERD) postoperatively and the solution for this problem has still been elusive. In this current issue of the journal, Nabi et al [ 2 ] have presented an excellent overview of the latest developments in predicting, preventing, evaluating, and managing GERD subsequent to POEM. Their review article looks into the various modifications of the POEM procedure and into the future perspectives for improving outcomes in relation to GERD.…”

“…The review article in this journal by Nabi et al [ 2 ], details the pros and cons of the various techniques of modification of the standard POEM procedure. The modifications focus on the location and length of the oesophageal and gastric myotomies and the techniques which allow preservation of the sling fibres of the Esophago-gastric junction (EGJ).…”