Single-session endoscopic fundoplication after peroral endoscopic myotomy (POEM+F) for prevention of post gastroesophageal reflux - 1-year follow-up study

Abstract

Background Peroral endoscopic myotomy (POEM) is an established treatment for achalasia cardia; however, post-POEM gastroesophageal reflux (GER) remains a significant problem. Concomitant endoscopic fundoplication following POEM (POEM+F) was recently described to reduce post-POEM GER. This single-center study reports short-term outcomes of POEM+F. Methods This was a retrospective analysis of a prospectively maintained database of patients undergoing POEM+F. Abstracted data included demographics, achalasia type, pre-POEM Eckardt score, prior therapy, follow-up.Follow-up assessment was 3-monthly for 1 year and included post-POEM Eckardt score, GerdQ score, wrap integrity and esophagitis on esophagogastroduodenoscopy, and pH studies. GER was defined according to Lyon Consensus. Results 25 patients underwent POEM+F (mean age 40.1 years [standard deviation (SD) 13.7]; 12 females). POEM+F was technically successful in 23/25 (92.0%). Significant dysphagia improvement was seen in all 25 patients (mean pre- and post-POEM Eckardt scores 8.21 [SD 1.08] and 0.1 [SD 0.3], respectively; P =0.001). Mean total procedure and fundoplication times were 115.6 (SD 27.2) minutes and 46.7 (SD 12.4) minutes, respectively; times reduced significantly after the initial five cases. Median follow-up was 12 months (interquartile range [IQR] 9-13). Intact wrap was seen in 19/23 (82.6%). GER (abnormal esophageal acid exposure time [EAET]) was seen in 2/18 (11.1%) and there was one reported GerdQ >8.Borderline GER (asymptomatic grade A esophagitis, normal EAET) was identified in 4/22 (18.2%). Three (12.0%) minor delayed adverse events occurred but required no intervention. Conclusions POEM+F was safe and reproducible. At 12 months' follow-up, incidence of post-POEM+F GER was low and acceptable.