ISSN: 2574-8009
Authors: Calderon LF, Canezaro H, Veeramachaneni H, Kile B2 Andrus V,Armstrong E, Okuampa D, Dies R, Deville A, Kawji L, Massaad J, Keilin SD and Cai Q
Introduction: Per-Oral Endoscopic Myotomy (POEM) is a specialized procedure designed to improve symptoms by minimizing lower esophageal sphincter pressure in patients with achalasia. Despite excellent reported success rates, about 10% of patients have persistent or recurrent symptoms after procedure. There are limited studies looking at the efficacy of redo POEMS for these patients. In particular, there is no published data on comparing the paired effect of index POEM and redo POEM individually. We aimed to compare paired data of index and redo POEMs and provide election criteria for redo POEM. Methods: We conducted a retrospective observational study of all patients who underwent both index and redo POEM between August 2014 and January 2020 at Emory University. All patients underwent standard POEM protocol. We defined clinical success by an Eckardt score <3 post procedure. Results were analyzed with t tests, Chi squared tests where appropriate, or were otherwise reported as means with corresponding ranges. Results: 15 patients underwent redo POEM (ages 25-79, 53% female). One was lost to long-term follow up. There was no significant difference noted between index and redo POEM in procedure time (61.9 minutes vs. 62.2 minutes) (p=0.96), myotomy length (6.9 cm vs.6.1 cm) (p=0.13). 10 out of 15 patients (67%) achieved clinical success post-procedure with an Eckhardt score <3. Conclusion: Redo POEM procedure can be safely performed even on the same side of index POEM. Patients with previous interventions, those who clinically failed index POEM (never-responders), and those who initial responded (recurred) all can benefit from and should be offered redo POEM procedure. However, patients with severely diffusely dilated esophagus may not benefit from redo POEM and warrant surgical consultation for esophagectomy, if necessary.
Keywords: POEM; Redo; Outcome; Achalasia
