Recurrent dysphagia after myotomy for achalasia: pneumatic dilation or POEM?,Surgical Endoscopy

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Recurrent dysphagia after myotomy for achalasia: pneumatic dilation or POEM?
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2022-09-19 , DOI: 10.1007/s00464-022-09556-5
Christopher Zimmermann ₁ , Nate Torell ₁ , Anne Lidor ₁ , Luke Funk ₁ , Amber Shada _{1,

2}

Affiliation

Introduction

Myotomy is the gold standard treatment for achalasia, yet long-term failure rates approach 15%. Treatment options for recurrent dysphagia include pneumatic dilation (PD), laparoscopic redo myotomy, per oral endoscopic myotomy (POEM), or esophagectomy. We employ both PD and POEM as first-line treatment for these patients. We evaluated operative success and patient reported outcomes for patients who underwent PD or POEM for recurrent dysphagia after myotomy.

Methods

We identified patients with achalasia who underwent PD or POEM for recurrent dysphagia after previous myotomy within a foregut database at our institution between 2013 and 2021. Gastroesophageal Reflux Disease-Health-Related quality of Life (GERD-HRQL) and Eckardt scores, and overall change in each were compared across PD and POEM groups. Successful treatment of dysphagia was defined by Eckardt scores ≤ 3.

Results

103 patients underwent myotomy for achalasia. Of these, 19 (18%) had either PD or POEM for recurrent dysphagia. Nine were treated with PD and 10 with POEM. The mean change in Eckardt and GERD-HRQL scores did not differ between groups. 50% of the PD group and 67% of the POEM group had resolution of their dysphagia symptoms (p = 0.65). Mean procedure length was greater in the POEM group (267 vs 72 min, p < 0.01) as was mean length of stay (1.56 vs 0.3 days, p < 0.01). There was one adverse event after PD and three adverse events after POEM. After PD, 7 patients (70%) required additional procedures compared to four patients (44%) in the POEM group, consisting mostly of repeat PD.

Conclusion

Patients undergoing PD or POEM for recurrent dysphagia after myotomy have similar rates of dysphagia resolution and reflux symptoms. Patients undergoing PD enjoy a shorter length of stay and shorter procedure time but may require more subsequent procedures.

中文翻译：

贲门失弛缓症肌切开术后复发性吞咽困难：气动扩张还是 POEM？

介绍

肌切开术是治疗贲门失弛缓症的金标准，但长期失败率接近 15%。复发性吞咽困难的治疗选择包括气动扩张术 (PD)、腹腔镜再次肌切开术、经口内窥镜肌切开术 (POEM) 或食管切除术。我们采用 PD 和 POEM 作为这些患者的一线治疗。我们评估了接受 PD 或 POEM 治疗肌切开术后复发性吞咽困难的患者的手术成功率和患者报告的结果。

方法

我们确定了 2013 年至 2021 年间在我们机构的前肠数据库中接受过 PD 或 POEM 治疗的贲门失弛缓症患者，这些患者在之前的肌切开术后复发性吞咽困难。胃食管反流病-健康相关生活质量 (GERD-HRQL) 和 Eckardt 评分以及总体变化每个都在 PD 和 POEM 组之间进行了比较。吞咽困难的成功治疗定义为 Eckardt 评分 ≤ 3。

结果

103 名患者因贲门失弛缓症接受了肌切开术。其中，19 名 (18%) 因复发性吞咽困难而患有 PD 或 POEM。9 人接受 PD 治疗，10 人接受 POEM 治疗。Eckardt 和 GERD-HRQL 分数的平均变化在各组之间没有差异。50% 的 PD 组和 67% 的 POEM 组吞咽困难症状得到缓解 ( p = 0.65)。POEM 组的平均手术时间更长（267 对 72 分钟，p < 0.01），平均住院时间也更长（1.56 对 0.3 天，p < 0.01）。PD 后有 1 例不良事件，POEM 后有 3 例不良事件。PD 后，7 名患者 (70%) 需要额外的程序，而 POEM 组有 4 名患者 (44%)，主要由重复 PD 组成。