Peroral endoscopic myotomy (POEM) for dysphagia and esophageal motor disorder after antireflux fundoplication.
(2020) Endoscopy — Vol. 52, n° 7, p. 583-588 (2020)
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- INTRODUCTION: Laparoscopic fundoplication is the treatment of severe and refractory gastroesophageal reflux disease (GERD). It induces dysphagia in 5 % - 10 % owing to a tight valve ± esophageal motility disorders (EMD), with challenging management. We assessed the first case series assessing peroral endoscopic myotomy (POEM) in such a situation. METHODS: A retrospective case series including eight patients with severe dysphagia after laparoscopic fundoplication who were treated by POEM. They were assessed clinically by Eckardt and Mellow - Pinkas dysphagia scores, and by high resolution manometry (HRM). The procedure was a regular esophageal POEM, mainly posterior, including a myotomy of the wrap. The objectives were to evaluate the clinical efficacy, technical difficulties, and complications of this approach. RESULTS: HRM showed aperistalsis in 6 /8 patients and raised lower esophageal sphincter (LES) pressure in 5 /8. The median preoperative Eckardt and dysphagia scores were 5 and 3.5, respectively. The procedure was completed in 7 /8 patients, with a clinical efficacy rate (normalization of both scores) of 75 % (6 /8). Although the submucosa seemed more fibrotic and vascularized, no severe complications occurred. CONCLUSION: POEM is a newly described therapeutic option to consider for managing dysphagia due to EMD after laparoscopic fundoplication.
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Gonzalez, J.-M., Monino, L., Ah-Soune, P., Vitton, V., & Barthet, M. (2020). Peroral endoscopic myotomy (POEM) for dysphagia and esophageal motor disorder after antireflux fundoplication. Endoscopy, 52(7), 583-588. https://doi.org/10.1055/a-1147-1348 (Original work published 2020)