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Technical Details and Outcomes of Peroral Endoscopic Myotomy with Fundoplication: The First U.S. Experience.

Published:October 17, 2022DOI:https://doi.org/10.1016/j.gie.2022.10.027
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      Abstract:

      Background and aims: Per Oral Endoscopic Myotomy (POEM) is an established endoscopic treatment for achalasia; however, post-POEM rates of gastroesophageal reflux disease (GERD) remain a significant cause of concern. Single session POEM with fundoplication (POEM-F) to treat achalasia was recently described to reduce post-POEM GERD. This study aims to report the technical feasibility, safety, and early outcomes of the first United States (U.S.) cohort of POEM-F.
      Methods: We retrospectively reviewed all patients with achalasia treated with POEM-F at our center. The primary endpoint was technical success, defined as the successful completion of all the steps of the POEM-F procedure.
      Results: A total of 6 patients (mean age 50±4.8 years; 1 female) underwent POEM-F for achalasia. Technical success was achieved in all patients (6/6), and no major immediate or delayed (up to 30 days post-procedure) adverse events were seen. At the one-month follow-up visit, the mean Eckardt score (ES) decreased from 8.8±1.1 to 0.3±0.5. The GERD-Health-related quality of life (GERD-HRQL) and reflux symptom index (RSI) scores obtained at one month follow-up, with patients on proton pump inhibitors, were 2.3±3.7 and 2.2±2.5, respectively.
      Conclusions: This first case series on POEM-F in the U.S. suggests that POEM-F is feasible and safe with excellent short-term outcomes.

      Keywords

      Abbreviations:

      POEM (Per Oral Endoscopic Myotomy), GERD (Gastroesophageal reflux disease), U.S (United States), ES (Eckardt score), GERD-HRQL (GERD-Health-related quality of life), RSI (Reflux symptom index), HM (Heller myotomy), POEM-F (Per oral endoscopic myotomy with fundoplication), NOTES (Natural orifice transluminal endoscopic surgery), BMI (Body mass index), GEJ (Gastroesophageal junction), TTSC (Through-the-scope clip), FLIP (Functional luminal imaging probe), PPI (Proton pump inhibitors), AE (Adverse event), SD (Standard deviation), DI (Distensibility index)
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