POEM more effective than previous estimates for achalasia
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Peroral endoscopic myotomy is highly safe and effective for at least 1 year for the treatment of achalasia and outperformed previous efficacy estimates, according to study results.
Haruhiro Inoue, MD, PhD, of the digestive disease center at Showa University Koto-Toyosu Hospital in Japan, and colleagues wrote that previous studies have found that POEM has a therapeutic efficacy — defined as an Eckardt score no greater than 3 — between 82% and 95% after 1 year.
“We expected equal satisfactory treatment outcomes for a multicenter prospective study performed in Japan,” they wrote in Gastrointestinal Endoscopy. “Therefore, the aim of this study was to prospectively verify the treatment outcomes after POEM at multiple facilities in Japan.”
Researchers performed a prospective, single-arm trial of POEM for achalasia at eight Japanese facilities between 2016 and 2018. In the trial, 233 patients with achalasia underwent POEM and were evaluated at 3 months and up to 1 year.
Twenty-four patients experienced procedure-related adverse events (10.3%), of which none needed surgical intervention.
Among 207 patients who fit inclusion criteria, the efficacy of POEM was 97.4% (95.3–99.7%). One year after the procedure, the Eckardt score decreased from 6.6 ± 2 to 1.1 ± 1.1.
Of 213 patients who had not received proton pump inhibitors before undergoing POEM, 14.7% had postoperative GERD and 21.1% received PPIs within 1 year. Additionally, 54.2% experienced reflux esophagitis and 5.6% experienced severe reflux esophagitis.
“Based on our results, we believe that POEM is potentially curative for most patients with achalasia, with durable results up to at least 1 year after the procedure,” Inoue and colleagues wrote. – by Alex Young
Disclosures: Inoue reports receiving research grants from Boston Scientific and Olympus outside the submitted work. The other authors report no relevant financial disclosures.
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