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Erschienen in: Surgical Endoscopy 3/2018


Per-oral endoscopic myotomy (POEM): mid-term efficacy and safety

verfasst von: Jan Martinek, Hana Svecova, Zuzana Vackova, Radek Dolezel, Ondrej Ngo, Jana Krajciova, Eva Kieslichova, Radim Janousek, Alexander Pazdro, Tomas Harustiak, Lucie Zdrhova, Pavla Loudova, Petr Stirand, Julius Spicak

Erschienen in: Surgical Endoscopy | Ausgabe 3/2018

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Background and aims

Per-oral endoscopic myotomy (POEM) is becoming a standard treatment for achalasia. Long-term efficacy and the rate of post-POEM reflux should be further investigated. The main aim of this study was to analyze safety and mid-term (12 and 24 months) clinical outcomes of POEM.


Data on single tertiary center procedures were collected prospectively. The primary outcome was treatment success defined as an Eckardt score < 3 at 12 and 24 months. A total of 155 consecutive patients with achalasia underwent POEM; 133 patients were included into the analysis (22 patients will be analyzed separately as part of a multicenter randomized clinical trial).


POEM was successfully completed in 132 (99.2%) patients, and the mean length of the procedure was 69.8 min (range 31–136). One patient underwent a drainage for pleural effusion; no other serious adverse events occurred. Treatment success at 3, 12, and 24 months was observed in 95.5% (CI 89.6–98.1), 93.4% (86.5–96.8), and 84.0% (71.4–91.4) of patients, respectively. A total of 11 patients (8.3%) reported initial treatment failure (n = 5) or later recurrence (n = 6). The majority of relapses occurred in patients with achalasia type I (16.7 vs. 1.1% achalasia type II vs. 0% achalasia type III; p<0.05). At 12 months, post-POEM reflux symptoms were present in 29.7% of patients. At 3 months, mild reflux esophagitis was diagnosed in 37.6% of patients, and pathological gastroesophageal reflux was detected in 41.5% of patients. A total of 37.8% of patients had been treated with a proton pump inhibitor.


POEM resulted in greater than 90% treatment success at 12 months which tends to decrease to 84% after 2 years. More than one-third of the patients had mild reflux symptoms and/or mild esophagitis.

  1. NOSCAR POEM White Paper Committee, Stavropoulos SN, Desilets DJ, Fuchs KH et al (2014) Per-oral endoscopic myotomy white paper summary. Gastrointest Endosc 80(1):1–15. doi:10.​1016/​j.​gie.​2014.​04.​014
  2. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42(4):265–271. doi:10.​1055/​s-0029-1244080 View ArticlePubMed
  3. Familiari P, Gigante G, Marchese M, Boskoski I, Tringali A, Perri V, Costamagna G (2014) Peroral endoscopic myotomy for esophageal achalasia: outcomes of the first 100 patients with short-term follow-up. Ann Surg 30(11):4817–4826
  4. Von Renteln D, Fuchs KH, Fockens P, Bauerfeind P, Vassiliou MC, Werner YB, Fried G, Breithaupt W, Heinrich H, Bredenoord AJ, Kersten JF, Verlaan T, Trevisonno M, Rösch T (2013) Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology 145(2):309-11.e1–309-11.e3. doi:10.​1053/​j.​gastro.​2013.​04.​057
  5. Von Renteln D, Inoue H, Minami H, Werner YB, Pace A, Kersten JF, Much CC, Schachschal G, Mann O, Keller J, Fuchs KH, Rösch T (2012) Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol 107(3):411–417. doi:10.​1038/​ajg.​2011.​388 View Article
  6. Teitelbaum EN, Soper NJ, Santos BF, Arafat FO, Pandolfino JE, Kahrilas PJ, Hirano I, Hungness ES (2014) Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for treatment of achalasia. Surg Endosc 28(12):3359–3365. doi:10.​1007/​s00464-014-3628-1 View ArticlePubMed
  7. Akintoye E, Kumar N, Obaitan I, Alayo Q, Thompson CC (2016) Peroral endoscopic myotomy: a meta-analysis. Endoscopy 48(12):1059–1068. doi:10.​1055/​s-0042-114426 View ArticlePubMed
  8. Inoue H, Sato H, Ikeda H, Onimaru M, Sato C, Minami H, Yokomichi H, Kobayashi Y, Grimes KL, Kudo SE (2015) Per-oral endoscopic myotomy: a series of 500 patients. J Am Coll Surg 221(2):256–264. doi:10.​1016/​j.​jamcollsurg.​2015.​03.​057 View ArticlePubMed
  9. Patel K, Abbassi-Ghadi N, Markar S, Kumar S, Jethwa P, Zaninotto G (2015) Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis. Dis Esophagus 29(7):807–819. doi:10.​1111/​dote.​12387 View ArticlePubMed
  10. Talukdar R, Inoue H, Nageshwar Reddy D (2015) Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis. Surg Endosc 29(11):3030–3046. doi:10.​1007/​s00464-014-4040-6 View ArticlePubMed
  11. Werner YB, Costamagna G, Swanström LL, von Renteln D, Familiari P, Sharata AM, Noder T, Schachschal G, Kersten JF, Rösch T (2015) Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut 65(6):899–906. doi:10.​1136/​gutjnl-2014-308649 View ArticlePubMed
  12. Bhayani NH, Kurian AA, Dunst CM, Sharata AM, Rieder E, Swanstrom LL (2014) A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann Surg 259(6):1098–1103. doi:10.​1097/​SLA.​0000000000000268​ View ArticlePubMed
  13. Stavropoulos SN, Modayil RJ, Friedel D, Savides T (2013) The International Per Oral Endoscopic Myotomy Survey (IPOEMS): a snapshot of the global POEM experience. Surg Endosc 27(9):3322–3338. doi:10.​1007/​s00464-013-2913-8 View ArticlePubMed
  14. Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmülling C, Neugebauer E, Troidl H (1995) Gastrointestinal quality of life index: development, validation and application of a new instrument. Br J Surg 82(2):216–222View ArticlePubMed
  15. Ramchandani M, Nageshwar Reddy D, Darisetty S, Kotla R, Chavan R, Kalpala R, Galasso D, Lakhtakia S, Rao GV (2016) Peroral endoscopic myotomy for achalasia cardia: treatment analysis and follow up of over 200 consecutive patients at a single center. Dig Endosc 28(1):19–26. doi:10.​1111/​den.​12495 View ArticlePubMed
  16. Swanstrom LL, Kurian A, Dunst CM, Sharata A, Bhayani N, Rieder E (2012) Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg 256(4):659–667. doi:10.​1097/​SLA.​0b013e31826b5212​ View ArticlePubMed
  17. Ngamruengphong S, Inoue H, Chiu P, Yip HC, Bapaye A, Ujiki M, Patel L, Desai PN, Hayee B, Haji A, Wong V, Perretta S, Dorwat S, Pioche M, Roman S, Rivory J, Mion F, Ponchon T, Garros A, Nakamura J, Hata Y, Balassone V, Onimaru M, Hajiyeva G, Ismail A, Chen YI, Bukhari M, Haito-Chavez Y, Kumbhari V, Maselli R, Repici A, Khashab MA (2016) Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 2 years: an international multicenter study. Gastrointest Endosc 85(5):927–933. doi:10.​1016/​j.​gie.​2016.​09.​017 View ArticlePubMed
  18. Hungness ES, Sternbach JM, Teitelbaum EN, Kahrilas PJ, Pandolfino JE, Soper NJ (2016) Per-oral Endoscopic Myotomy (POEM) after the learning curve: durable long-term results with a low complication rate. Ann Surg 264(3):508–517. doi:10.​1097/​SLA.​0000000000001870​ View ArticlePubMed
  19. Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttitta A, Elizalde JI, Fumagalli U, Gaudric M, Rohof WO, Smout AJ, Tack J, Zwinderman AH, Zaninotto G, Busch OR, European Achalasia Trial Investigators (2011) Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 364(19):1807–1816. doi:10.​1056/​NEJMoa1010502
  20. Moonen A, Annese V, Belmans A, Bredenoord AJ, Bruley des Varannes S, Costantini M, Dousset B, Elizalde JI, Fumagalli U, Gaudric M, Merla A, Smout AJ, Tack J, Zaninotto G, Busch OR, Boeckxstaens GE (2016) Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut 65(5):732–739. doi:10.​1136/​gutjnl-2015-310602
  21. Yaghoobi M, Mayrand S, Martel M, Roshan-Afshar I, Bijarchi R, Barkun A (2013) Laparoscopic Heller’s myotomy versus pneumatic dilation in the treatment of idiopathic achalasia: a meta-analysis of randomized, controlled trials. Gastrointest Endosc 78(3):468–475. doi:10.​1016/​j.​gie.​2013.​03.​1335 View ArticlePubMed
  22. Roman S, Kahrilas PJ, Mion F, Nealis TB, Soper NJ, Poncet G, Nicodème F, Hungness E, Pandolfino JE (2013) Partial recovery of peristalsis after myotomy for achalasia: more the rule than the exception. JAMA Surg 148(2):157–164. doi:10.​1001/​2013.​jamasurg.​38 View ArticlePubMedPubMed Central
  23. Rawlings A, Soper NJ, Oelschlager B, Swanstrom L, Matthews BD, Pellegrini C, Pierce RA, Pryor A, Martin V, Frisella MM, Cassera M, Brunt LM (2012) Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc 26(1):18–26. doi:10.​1007/​s00464-011-1822-y View ArticlePubMed
  24. Falkenback D, Johansson J, Oberg S, Kjellin A, Wenner J, Zilling T, Johnsson F, Von Holstein CS, Walther B (2003) Heller’s esophagomyotomy with or without a 360 degrees floppy Nissen fundoplication for achalasia. Long-term results from a prospective randomized study. Dis Esophagus 16(4):284–290View ArticlePubMed
  25. Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW (2004) Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg 240(3):405–412; discussion 412–415
  26. Kurian AA, Dunst CM, Sharata A, Bhayani NH, Reavis KM, Swanström LL (2013) Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc 77(5):719–725. doi:10.​1016/​j.​gie.​2012.​12.​006 View ArticlePubMed
  27. Teitelbaum EN, Soper NJ, Arafat FO, Santos BF, Kahrilas PJ, Pandolfino JE, Hungness ES (2014) Analysis of a learning curve and predictors of intraoperative difficulty for peroral esophageal myotomy (POEM). J Gastrointest Surg 18(1):92–98; discussion 98–99. doi:10.​1007/​s11605-013-2332-0
  28. Patel KS, Calixte R, Modayil RJ, Friedel D, Brathwaite CE, Stavropoulos SN (2015) The light at the end of the tunnel: a single-operator learning curve analysis for per oral endoscopic myotomy. Gastrointest Endosc 81(5):1181–1187. doi:10.​1016/​j.​gie.​2014.​10.​002 View ArticlePubMed
  29. Ross SW, Oommen B, Wormer BA, Walters AL, Matthews BD, Heniford BT, Augenstein VA (2015) National outcomes of laparoscopic Heller myotomy: operative complications and risk factors for adverse events. Surg Endosc 29(11):3097–3105. doi:10.​1007/​s00464-014-4054-0 View ArticlePubMed
Per-oral endoscopic myotomy (POEM): mid-term efficacy and safety
verfasst von
Jan Martinek
Hana Svecova
Zuzana Vackova
Radek Dolezel
Ondrej Ngo
Jana Krajciova
Eva Kieslichova
Radim Janousek
Alexander Pazdro
Tomas Harustiak
Lucie Zdrhova
Pavla Loudova
Petr Stirand
Julius Spicak
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 3/2018
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218

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