Long-term outcomes of per-oral endoscopic myotomy in patients with achalasia with a minimum follow-up of 2 years: An international multicenter study

Saowanee Ngamruengphong, Haruhiro Inoue, Philip Wai Yan Chiu, Hon Chi Yip, Amol Bapaye, Michael B. Ujiki, Lava Patel, Pankaj N. Desai, Bu Hayee, Amyn Haji, Vivien Wai yin Wong, Silvana Perretta, Shivangi Dorwat, Mathieu Pioche, Sabine Roman, Jérôme Rivory, François Mion, Thierry Ponchon, Aurélien Garros, Jun NakamuraYoshitaka Hata, Valerio Balassone, Manabu Onimaru, Gulara Hajiyeva, Amr Ismail, Yen I. Chen, Majidah Bukhari, Yamile Haito-Chavez, Vivek Kumbhari, Roberta Maselli, Alessandro Repici, Mouen A. Khashab

Research output: Contribution to journalArticle

Abstract

Background and Aims: Per-oral endoscopic myotomy (POEM) has shown promising safety and efficacy in short-term studies. However, long-term follow-up data are very limited. The aims of this study were to assess (1) clinical outcome of patients with a minimum post-POEM follow-up of 2 years and (2) factors associated with long-term clinical failure after POEM. Methods: A retrospective chart review was performed that included all consecutive patients with achalasia who underwent POEM with a minimum follow-up of 2 years at 10 tertiary-care centers. Clinical response was defined by a decrease in Eckardt score to 3 or lower. Results: A total of 205 patients (45.8% men; mean age, 49 years) were followed for a median of 31 months (interquartile range, 26-38 months). Of these, 81 patients (39.5%) had received previous treatment for achalasia before POEM. Clinical success was achieved in 98% (185/189), 98% (142/144), and 91% (187/205) of patients with follow-up within 6 months, at 12 months, and ≥24 months, respectively. Of 185 patients with clinical response at 6 months, 11 (6%) experienced recurrent symptoms at 2 years. History of previous pneumatic dilation was associated with long-term treatment failure (odds ratio, 3.41; 95% confidence interval, 1.25-9.23). Procedure-related adverse events occurred in 8.2% of patients and only 1 patient required surgical intervention. Abnormal esophageal acid exposure and reflux esophagitis were documented in 37.5% and 18% of patients, respectively. However, these rates are simply a reference number among a very selective group of patients. Conclusions: POEM is safe and provides high initial clinical success and excellent long-term outcomes. Among patients with confirmed clinical response within 6 months, 6% had recurrent symptoms by 2 years.

Original languageEnglish
JournalGastrointestinal Endoscopy
DOIs
Publication statusAccepted/In press - May 5 2016

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Esophageal Achalasia
Multicenter Studies
Peptic Esophagitis
Treatment Failure
Tertiary Care Centers
Dilatation
Odds Ratio
Confidence Intervals

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Long-term outcomes of per-oral endoscopic myotomy in patients with achalasia with a minimum follow-up of 2 years : An international multicenter study. / Ngamruengphong, Saowanee; Inoue, Haruhiro; Chiu, Philip Wai Yan; Yip, Hon Chi; Bapaye, Amol; Ujiki, Michael B.; Patel, Lava; Desai, Pankaj N.; Hayee, Bu; Haji, Amyn; Wong, Vivien Wai yin; Perretta, Silvana; Dorwat, Shivangi; Pioche, Mathieu; Roman, Sabine; Rivory, Jérôme; Mion, François; Ponchon, Thierry; Garros, Aurélien; Nakamura, Jun; Hata, Yoshitaka; Balassone, Valerio; Onimaru, Manabu; Hajiyeva, Gulara; Ismail, Amr; Chen, Yen I.; Bukhari, Majidah; Haito-Chavez, Yamile; Kumbhari, Vivek; Maselli, Roberta; Repici, Alessandro; Khashab, Mouen A.

In: Gastrointestinal Endoscopy, 05.05.2016.

Research output: Contribution to journalArticle

Ngamruengphong, S, Inoue, H, Chiu, PWY, Yip, HC, Bapaye, A, Ujiki, MB, Patel, L, Desai, PN, Hayee, B, Haji, A, Wong, VWY, Perretta, S, Dorwat, S, Pioche, M, Roman, S, Rivory, J, Mion, F, Ponchon, T, Garros, A, Nakamura, J, Hata, Y, Balassone, V, Onimaru, M, Hajiyeva, G, Ismail, A, Chen, YI, Bukhari, M, Haito-Chavez, Y, Kumbhari, V, Maselli, R, Repici, A & Khashab, MA 2016, 'Long-term outcomes of per-oral endoscopic myotomy in patients with achalasia with a minimum follow-up of 2 years: An international multicenter study', Gastrointestinal Endoscopy. https://doi.org/10.1016/j.gie.2016.09.017
Ngamruengphong, Saowanee ; Inoue, Haruhiro ; Chiu, Philip Wai Yan ; Yip, Hon Chi ; Bapaye, Amol ; Ujiki, Michael B. ; Patel, Lava ; Desai, Pankaj N. ; Hayee, Bu ; Haji, Amyn ; Wong, Vivien Wai yin ; Perretta, Silvana ; Dorwat, Shivangi ; Pioche, Mathieu ; Roman, Sabine ; Rivory, Jérôme ; Mion, François ; Ponchon, Thierry ; Garros, Aurélien ; Nakamura, Jun ; Hata, Yoshitaka ; Balassone, Valerio ; Onimaru, Manabu ; Hajiyeva, Gulara ; Ismail, Amr ; Chen, Yen I. ; Bukhari, Majidah ; Haito-Chavez, Yamile ; Kumbhari, Vivek ; Maselli, Roberta ; Repici, Alessandro ; Khashab, Mouen A. / Long-term outcomes of per-oral endoscopic myotomy in patients with achalasia with a minimum follow-up of 2 years : An international multicenter study. In: Gastrointestinal Endoscopy. 2016.
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abstract = "Background and Aims: Per-oral endoscopic myotomy (POEM) has shown promising safety and efficacy in short-term studies. However, long-term follow-up data are very limited. The aims of this study were to assess (1) clinical outcome of patients with a minimum post-POEM follow-up of 2 years and (2) factors associated with long-term clinical failure after POEM. Methods: A retrospective chart review was performed that included all consecutive patients with achalasia who underwent POEM with a minimum follow-up of 2 years at 10 tertiary-care centers. Clinical response was defined by a decrease in Eckardt score to 3 or lower. Results: A total of 205 patients (45.8{\%} men; mean age, 49 years) were followed for a median of 31 months (interquartile range, 26-38 months). Of these, 81 patients (39.5{\%}) had received previous treatment for achalasia before POEM. Clinical success was achieved in 98{\%} (185/189), 98{\%} (142/144), and 91{\%} (187/205) of patients with follow-up within 6 months, at 12 months, and ≥24 months, respectively. Of 185 patients with clinical response at 6 months, 11 (6{\%}) experienced recurrent symptoms at 2 years. History of previous pneumatic dilation was associated with long-term treatment failure (odds ratio, 3.41; 95{\%} confidence interval, 1.25-9.23). Procedure-related adverse events occurred in 8.2{\%} of patients and only 1 patient required surgical intervention. Abnormal esophageal acid exposure and reflux esophagitis were documented in 37.5{\%} and 18{\%} of patients, respectively. However, these rates are simply a reference number among a very selective group of patients. Conclusions: POEM is safe and provides high initial clinical success and excellent long-term outcomes. Among patients with confirmed clinical response within 6 months, 6{\%} had recurrent symptoms by 2 years.",
author = "Saowanee Ngamruengphong and Haruhiro Inoue and Chiu, {Philip Wai Yan} and Yip, {Hon Chi} and Amol Bapaye and Ujiki, {Michael B.} and Lava Patel and Desai, {Pankaj N.} and Bu Hayee and Amyn Haji and Wong, {Vivien Wai yin} and Silvana Perretta and Shivangi Dorwat and Mathieu Pioche and Sabine Roman and J{\'e}r{\^o}me Rivory and Fran{\cc}ois Mion and Thierry Ponchon and Aur{\'e}lien Garros and Jun Nakamura and Yoshitaka Hata and Valerio Balassone and Manabu Onimaru and Gulara Hajiyeva and Amr Ismail and Chen, {Yen I.} and Majidah Bukhari and Yamile Haito-Chavez and Vivek Kumbhari and Roberta Maselli and Alessandro Repici and Khashab, {Mouen A.}",
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T1 - Long-term outcomes of per-oral endoscopic myotomy in patients with achalasia with a minimum follow-up of 2 years

T2 - An international multicenter study

AU - Ngamruengphong, Saowanee

AU - Inoue, Haruhiro

AU - Chiu, Philip Wai Yan

AU - Yip, Hon Chi

AU - Bapaye, Amol

AU - Ujiki, Michael B.

AU - Patel, Lava

AU - Desai, Pankaj N.

AU - Hayee, Bu

AU - Haji, Amyn

AU - Wong, Vivien Wai yin

AU - Perretta, Silvana

AU - Dorwat, Shivangi

AU - Pioche, Mathieu

AU - Roman, Sabine

AU - Rivory, Jérôme

AU - Mion, François

AU - Ponchon, Thierry

AU - Garros, Aurélien

AU - Nakamura, Jun

AU - Hata, Yoshitaka

AU - Balassone, Valerio

AU - Onimaru, Manabu

AU - Hajiyeva, Gulara

AU - Ismail, Amr

AU - Chen, Yen I.

AU - Bukhari, Majidah

AU - Haito-Chavez, Yamile

AU - Kumbhari, Vivek

AU - Maselli, Roberta

AU - Repici, Alessandro

AU - Khashab, Mouen A.

PY - 2016/5/5

Y1 - 2016/5/5

N2 - Background and Aims: Per-oral endoscopic myotomy (POEM) has shown promising safety and efficacy in short-term studies. However, long-term follow-up data are very limited. The aims of this study were to assess (1) clinical outcome of patients with a minimum post-POEM follow-up of 2 years and (2) factors associated with long-term clinical failure after POEM. Methods: A retrospective chart review was performed that included all consecutive patients with achalasia who underwent POEM with a minimum follow-up of 2 years at 10 tertiary-care centers. Clinical response was defined by a decrease in Eckardt score to 3 or lower. Results: A total of 205 patients (45.8% men; mean age, 49 years) were followed for a median of 31 months (interquartile range, 26-38 months). Of these, 81 patients (39.5%) had received previous treatment for achalasia before POEM. Clinical success was achieved in 98% (185/189), 98% (142/144), and 91% (187/205) of patients with follow-up within 6 months, at 12 months, and ≥24 months, respectively. Of 185 patients with clinical response at 6 months, 11 (6%) experienced recurrent symptoms at 2 years. History of previous pneumatic dilation was associated with long-term treatment failure (odds ratio, 3.41; 95% confidence interval, 1.25-9.23). Procedure-related adverse events occurred in 8.2% of patients and only 1 patient required surgical intervention. Abnormal esophageal acid exposure and reflux esophagitis were documented in 37.5% and 18% of patients, respectively. However, these rates are simply a reference number among a very selective group of patients. Conclusions: POEM is safe and provides high initial clinical success and excellent long-term outcomes. Among patients with confirmed clinical response within 6 months, 6% had recurrent symptoms by 2 years.

AB - Background and Aims: Per-oral endoscopic myotomy (POEM) has shown promising safety and efficacy in short-term studies. However, long-term follow-up data are very limited. The aims of this study were to assess (1) clinical outcome of patients with a minimum post-POEM follow-up of 2 years and (2) factors associated with long-term clinical failure after POEM. Methods: A retrospective chart review was performed that included all consecutive patients with achalasia who underwent POEM with a minimum follow-up of 2 years at 10 tertiary-care centers. Clinical response was defined by a decrease in Eckardt score to 3 or lower. Results: A total of 205 patients (45.8% men; mean age, 49 years) were followed for a median of 31 months (interquartile range, 26-38 months). Of these, 81 patients (39.5%) had received previous treatment for achalasia before POEM. Clinical success was achieved in 98% (185/189), 98% (142/144), and 91% (187/205) of patients with follow-up within 6 months, at 12 months, and ≥24 months, respectively. Of 185 patients with clinical response at 6 months, 11 (6%) experienced recurrent symptoms at 2 years. History of previous pneumatic dilation was associated with long-term treatment failure (odds ratio, 3.41; 95% confidence interval, 1.25-9.23). Procedure-related adverse events occurred in 8.2% of patients and only 1 patient required surgical intervention. Abnormal esophageal acid exposure and reflux esophagitis were documented in 37.5% and 18% of patients, respectively. However, these rates are simply a reference number among a very selective group of patients. Conclusions: POEM is safe and provides high initial clinical success and excellent long-term outcomes. Among patients with confirmed clinical response within 6 months, 6% had recurrent symptoms by 2 years.

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