Outcomes After Per-Oral Endoscopic Myotomy at Three Years and Beyond
Refereed conference paper presented and published in conference proceedings


摘要Background: Per-oral endoscopic myotomy (POEM) has emerged as a promising novel treatment modality for achalasia, first performed clinically in September, 2008 in Japan. To date, reports on long term result is still lacking. Most reports are of 2 years after the procedure, and only one published report with follow-up 3 years or beyond is present. The aim of this study is to review the long-term outcomes of our cases with POEM done at least 3 years ago.

Medical records patients that have received the procedure of POEM in Prince of Wales Hospital, the Chinese University of Hong Kong were reviewed. Those who have had received the procedure for at least 3 years were studied. Patient characteristics, operative details and clinical outcomes were analysed.

One hundred and ten POEMs have been performed since July, 2010 in Prince of Wales Hospital, Hong Kong. Forty-seven cases were performed from July, 2010 to November, 2013. There were 28 females and 18 males, and their median age was 49 (range 18 to 87). Indications for POEM were mostly Type I or II achalasia (16 Type I, 17 Type II, 2 Type III, 4 esophagogastric outflow obstruction), and 2 had a sigmoid esophagus. Ten of these patients had previous treatment for achalasia (8 with pneumodilatation and 2 with Heller’s myotomy), and duration of symptoms ranged from 3 to 240 months (median 49 months). All procedures were performed under general anesthesia. The median operating time was 95 minutes. All myotomies were done selectively to the circular muscle anteriorly (except for the two cases who had previous Heller’s myotomy done), with a median length of 10cm (3cm over the gastric side). One case complicated with pneumonia, and median duration of hospital stay was 3 days (range 2 to 7 days). Median duration of follow-up for these patients was 42.3 months (range 5.2 to 71.4 months), and 93.5% had Eckardt score of less than 3 (median 0, range 0 to 3). The median Eckardt score dropped from 5 to 0 (p<0.001, Wilcoxon signed rank test). Eight of them (17%) complaint of reflux symptoms, all of which were well-controlled with proton pump inhibitors. Twenty-four patients had a follow-up upper endoscopy done since after POEM, of which 12 had one at or beyond three years after the procedure (median 49.9 months). Six of them (50%) showed endoscopic evidence of esophagitis, all of which were LA grade B or below.

Per-oral endoscopic myotomy continues to prove itself a safe and effective treatment for dysphagia in patients with achalasia, with clinical success of 93.5% at three years in our series. Rate of endoscopic evidence of gastroesophageal reflux is quite high in this study, but may well be due to selection bias. Further clinical follow-up with regular endoscopy, manometry and pH studies will be important for assessing the novel technique.
著者Wong VW, Chiu PWY, Wu JC, Yip HC, Chan SM, Liu SY, Teoh AY, Wong SK, Ng EK
會議名稱Digestive Disease Week 2017
會議地點Chicago, Illinois
會議論文集題名Gastrointestinal Endoscopy
期次5 Supplement
頁次AB596 - AB596
Web of Science 學科類別Gastroenterology & Hepatology;Gastroenterology & Hepatology

上次更新時間 2020-05-08 於 02:50