PMID- 25934759
OWN - NLM
STAT- MEDLINE
DCOM- 20170807
LR  - 20220318
IS  - 1468-3288 (Electronic)
IS  - 0017-5749 (Linking)
VI  - 65
IP  - 6
DP  - 2016 Jun
TI  - Clinical response to peroral endoscopic myotomy in patients with idiopathic 
      achalasia at a minimum follow-up of 2 years.
PG  - 899-906
LID - 10.1136/gutjnl-2014-308649 [doi]
AB  - BACKGROUND: The recently developed technique for peroral endoscopic myotomy 
      (POEM) has been shown to be effective in several short-term studies. Longer term 
      outcome data are largely non-existent. OBJECTIVE: To systematically report 
      clinical outcome with a minimum post-POEM follow-up of 2 years. DESIGN: All 
      patients treated consecutively by POEM for achalasia at three centres were 
      retrospectively analysed, with a minimum follow-up of 2 years. The main outcome 
      was the rate of POEM failures (Eckardt score >3) related to follow-up time. 
      RESULTS: Of 85 patients treated, five (5.9%) cases were excluded due to protocol 
      violation or loss to follow-up; the remaining 80 patients (mean age 44.9 years, 
      54% men) were followed clinically for 29 months (range 24-41). Initial clinical 
      response was observed in 77 cases (96.3%). Clinical recurrences (later failures) 
      were seen in a further 14 cases (17.7%), accounting for a total failure rate of 
      21.5%. In a multivariate analysis, age and endoscopic reflux signs were 
      independent predictors of treatment success. Of the 17 failures, eight were among 
      the first 10 cases treated in the participating centres. Reflux-associated 
      sequelae included one case of a severe reflux-associated stricture requiring 
      dilatation, and two patients with minor transient Eckardt score elevations 
      curable by proton pump inhibitor (PPI) treatment. Endoscopic signs of reflux 
      oesophagitis, mostly Los Angeles grade A/B, were seen in 37.5% (37/72) at the 
      2-year control. CONCLUSIONS: In this multicentre retrospective analysis, a high 
      initial success rate of POEM is followed by a mid-term recurrence rate of 18%. 
      Reflux oesophagitis, albeit mild, is frequent and should probably be treated by 
      regular low-dose PPI therapy. TRIAL REGISTRATION NUMBER: NCT 01405417 (UKE 
      study).
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not 
      already granted under a licence) please go to 
      http://www.bmj.com/company/products-services/rights-and-licensing/
FAU - Werner, Yuki B
AU  - Werner YB
AD  - Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, 
      Hamburg, Germany Department of Gastroenterology, University Hospital 
      Hamburg-Eppendorf, Hamburg, Germany.
FAU - Costamagna, Guido
AU  - Costamagna G
AD  - Digestive Endoscopy Unit, Universita Cattolica del Sacro Cuore, Rome, Italy.
FAU - Swanstrom, Lee L
AU  - Swanstrom LL
AD  - Providence Cancer Center, Portland, Oregon, USA.
FAU - von Renteln, Daniel
AU  - von Renteln D
AD  - Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, 
      Hamburg, Germany Department of Gastroenterology, Centre Hospitalier de 
      L'Universite de Montreal, Montreal, Quebec, Canada.
FAU - Familiari, Pietro
AU  - Familiari P
AD  - Digestive Endoscopy Unit, Universita Cattolica del Sacro Cuore, Rome, Italy.
FAU - Sharata, Ahmed M
AU  - Sharata AM
AD  - Providence Cancer Center, Portland, Oregon, USA.
FAU - Noder, Tania
AU  - Noder T
AD  - Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, 
      Hamburg, Germany.
FAU - Schachschal, Guido
AU  - Schachschal G
AD  - Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, 
      Hamburg, Germany.
FAU - Kersten, Jan F
AU  - Kersten JF
AD  - Department of Medical Biometry and Epidemiology, University Hospital 
      Hamburg-Eppendorf, Hamburg, Germany.
FAU - Rosch, Thomas
AU  - Rosch T
AD  - Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, 
      Hamburg, Germany.
LA  - eng
SI  - ClinicalTrials.gov/NCT01405417
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150430
PL  - England
TA  - Gut
JT  - Gut
JID - 2985108R
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Child
MH  - Esophageal Achalasia/*surgery
MH  - Esophageal Sphincter, Lower/surgery
MH  - *Esophagoscopy/methods
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Manometry/methods
MH  - Middle Aged
MH  - *Natural Orifice Endoscopic Surgery/methods
MH  - Recurrence
MH  - Reoperation
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - ACHALASIA
OT  - ENDOSCOPY
EDAT- 2015/05/03 06:00
MHDA- 2017/08/08 06:00
CRDT- 2015/05/03 06:00
PHST- 2014/10/17 00:00 [received]
PHST- 2015/03/31 00:00 [accepted]
PHST- 2015/05/03 06:00 [entrez]
PHST- 2015/05/03 06:00 [pubmed]
PHST- 2017/08/08 06:00 [medline]
AID - gutjnl-2014-308649 [pii]
AID - 10.1136/gutjnl-2014-308649 [doi]
PST - ppublish
SO  - Gut. 2016 Jun;65(6):899-906. doi: 10.1136/gutjnl-2014-308649. Epub 2015 Apr 30.