Management of Patients after Failed Peroral Endoscopic Myotomy: a Multicenter Study.

ola Kala shared this article with you from Inoreader Management of Patients after Failed Peroral Endoscopic Myotomy: a Multicenter Study. Μέσω pubmed: peroral endoscopic m... Related Articles Management of Patients after Failed Peroral Endoscopic Myotomy: a Multicenter Study. Endoscopy. 2020 Nov 16;: Authors: Ichkhanian Y, Assis D, Familiari P, Ujiki MB, Su B, Khan SR, Pioche M, Draganov PV, Young Cho J, Eleftheriadis N, Barret M, Haji A, Velanovich V, Tantau M, Marks J, Bapaye A, Sedarat A, Albéniz E, Bechara R, Kumta NA, Costamagna G, Perbtani Y, Patel M, Sippey M, Korrapati SK, Jain R, Estremera Arevalo F, El Zein MH, Brewer Gutierrez OI, Khashab MA Abstract BACKGROUND AND AIMS: Although Peroral Endoscopic Myotomy (POEM) is highly effective for the management of achalasia, clinical failures may occur. The optimal management of patients who fail POEM is not well known. This study aims to compare the outcomes of different management strategies in patients who had failed POEM. PATIENTS AND METHODS: This is an international, multicenter, retrospective study at 16 tertiary centers between 1/2012 and 11/2019. All patients who underwent POEM and experienced persistent or recurrent symptoms (Eckardt score (ES) > 3) were included. The primary outcome was to compare the rate of clinical success (ES ≤ 3) between different management strategies. RESULTS: A total of 99 patients (50 (50.5%) males, mean age 51.4 (16.2) yrs.) experienced clinical failure during the study period with a mean ES of 5.5 (0.2). A total of 29 (32.2%) patients were managed conservatively and 70 (71%) underwent re-treatment [repeat POEM 33 (33%), pneumatic dilation (PD) 30 (30%), and laparoscopic Heller myotomy (LHM) 7 (7.1%)]. During a median follow-up of 10 (IQR: 3-20) months, clinical success was highest in patients who underwent repeat POEM (25/33 (76%), mean ES 2.1 (2.1)), followed by PD (18/30 (60%), mean ES 2.8 (2.3)), and LHM (2/7 (29%), 4 (1.8)) (p=0.12). A total of 11 (37.9%, mean ES 4 (1.8)) patients in the conservative achieved clinical success. CONCLUSION: This study comprehensively assessed an international cohort of patients who underwent management of failed POEM. Repeat POEM and PD achieved acceptable clinical success with excellent safety profile. PMID: 33197943 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.