Clinical Endoscopy

Original Articles

Timed barium esophagography to predict recurrent achalasia after peroral endoscopic myotomy: a retrospective study in Thailand: Tharathorn Suwatthanarak, Chainarong Phalanusitthepa, Chatbadin Thongchuam, Thawatchai Akaraviputh, Vitoon Chinswangwatanakul, Thikhamporn Tawantanakorn, Somchai Leelakusolvong, Monthira Maneerattanaporn, Piyaporn Apisarnthanarak, Jitladda Wasinrat; Clin Endosc 2024;57(5):610-619. Published online June 14, 2024; DOI: https://doi.org/10.5946/ce.2023.236

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Background
/Aims: Achalasia is a rare esophageal motility disease, for which peroral endoscopic myotomy (POEM) has emerged as a promising treatment option; however, recurrence remains a challenge. Timed barium esophagography (TBE) is a useful diagnostic tool and potential outcome predictor of achalasia. This study aimed to determine predictive tools for recurrence after POEM.
Methods
This retrospective study enrolled achalasia patients who underwent POEM between January 2015 and December 2021. Patients were categorized into two groups using the 1-month post-POEM Eckardt scores and TBE: the discordant group (Eckardt score improved >50%, TBE decreased <50%) and the concordant group (both Eckardt score and TBE improved >50%). Recurrence was defined as a reincrease in the Eckardt score to more than three during follow-up.
Results
Complete medical records were available in 30 patients who underwent POEM. Seventeen patients (56.7%) were classified into the discordant group, while 13 patients (43.3%) were in the concordant group. The overall recurrence rate was 11.9% at 1-year, increasing to 23.8% during the extended follow-up. The discordant group had a 6.87 fold higher recurrence rate than the concordant group (52.9% vs. 7.7%, p=0.017).
Conclusions
These results strongly suggest that combining the Eckardt score with TBE can effectively predict recurrent achalasia after POEM. Patients in the discordant group had an elevated risk.

Citations

Citations to this article as recorded by

Assessment and Management of Reflux‐Related Esophageal Stricture After Peroral Endoscopic Myotomy in Achalasia
Shao‐Bin Luo, Zu‐Qiang Liu, Li Wang, Ming‐Yan Cai, Quan‐Lin Li, Ping‐Hong Zhou, Wei‐Feng Chen
Journal of Gastroenterology and Hepatology.2026; 41(1): 248. CrossRef
Pressure‐flow analysis following peroral endoscopic myotomy in pediatric achalasia: Novel insights into esophageal emptying
Renato Tambucci, Giulia Chiarazzo, Nathalie Rommel, Chiara Imondi, Tamara Caldaro, Paola De Angelis, Valerio Balassone
Journal of Pediatric Gastroenterology and Nutrition.2026;[Epub] CrossRef
Never judge a book by its cover: the role of timed barium esophagography in patients with complete symptom relief after peroral endoscopic myotomy
Tae Hee Lee
Clinical Endoscopy.2024; 57(5): 604. CrossRef

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Experience with Peroral Endoscopic Myotomy for Achalasia and Spastic Esophageal Motility Disorders at a Tertiary U.S. Center: Maen Masadeh, Peter Nau, Subhash Chandra, Jagpal Klair, John Keech, Kalpaj Parekh, Rami El Abiad, Henning Gerke; Clin Endosc 2020;53(3):321-327. Published online November 20, 2019; DOI: https://doi.org/10.5946/ce.2019.110

Abstract PDF PubReader ePub

Background
/Aims: Peroral endoscopic myotomy (POEM) is a novel procedure for the treatment of achalasia and spastic esophageal disorders. Experience with POEM is limited, but its reported outcomes are excellent. It is deemed safe even for patients with prior interventions.
Methods
This retrospective review included patients who underwent POEM at a tertiary US center. POEM was performed in a multidisciplinary approach by advanced endoscopists and foregut surgeons. Clinical success was defined as a post-POEM Eckardt score ≤3.
Results
A total of 125 patients were included. Median follow-up period was 18 months (interquartile range, 10–22 months). Clinical success was achieved in 92% of patients and persisted at 12 months in 88% of patients. Mucosal barrier failure (MBF) occurred in 7 patients, 2 of whom required surgical intervention. MBF was more common in patients with prior laparoscopic Heller myotomy (19% vs. 3%, p=0.015). MBF requiring surgical intervention occurred early in the learning curve.
Conclusions
POEM is safe and effective in the treatment of achalasia and spastic esophageal disorders even after failed prior interventions.

Citations

Citations to this article as recorded by

Comparing clinical outcomes of peroral endoscopic myotomy for achalasia between Eastern and Western countries: a systematic review and meta-analysis
Han Zhang, Xinxin Pu, Shu Huang, Huifang Xia, Kang Zou, Xinyi Zeng, Jiao Jiang, Wensen Ren, Yan Peng, Muhan Lü, Xiaowei Tang
Diseases of the Esophagus.2024;[Epub] CrossRef
Surgical and per-oral endoscopic myotomy (POEM) for the treatment of primary esophageal motility disorders: A systematic analysis of current trends in Germany between 2011 and 2019
Jennis Kandler, Tobias Essing, David Schöler, Georg Flügen, Wolfram T. Knoefel, Christoph Roderburg, Tom Luedde, Sven H. Loosen, Dong Keon Yon
PLOS ONE.2024; 19(1): e0297265. CrossRef
Learning curve for esophageal peroral endoscopic myotomy: a systematic review and meta-analysis
Srinivas R. Puli, Mihir S. Wagh, David Forcione, Harishankar Gopakumar
Endoscopy.2023; 55(04): 355. CrossRef
Management of the patient with esophagogastric junction outflow obstruction
Dariush Shahsavari, Zubair Malik, Henry P. Parkman
Current Opinion in Gastroenterology.2021; 37(4): 397. CrossRef
Long-term Outcomes of Per-oral Endoscopic Myotomy in Spastic Esophageal Motility Disorders
Zaheer Nabi, Radhika Chavan, Mohan Ramchandani, Jahangeer Basha, Nitin Jagtap, Arun Karyampudi, Santosh Darisetty, Manu Tandan, Rajesh Goud, Guduru Venkat Rao, Duvvur Nageshwar Reddy
Journal of Clinical Gastroenterology.2021; 55(7): 594. CrossRef
Outcomes of peroral endoscopic myotomy in patients with achalasia and prior bariatric surgery: A multicenter experience
S Bomman, J S Klair, M Ashat, R El Abiad, H Gerke, J Keech, K Parekh, P Nau, Y Hanada, L M Wong Kee Song, R Kozarek, S Irani, D Low, A Ross, R Krishnamoorthi
Diseases of the Esophagus.2021;[Epub] CrossRef
Spastic Motility Disorders: Diagnosis and Management in the Era of the Chicago Classification
Mario Costantini, Renato Salvador, Andrea Costantini
Foregut: The Journal of the American Foregut Society.2021; 1(3): 254. CrossRef
Non-achalasia esophageal motility disorders: Role of per-oral endoscopic myotomy
Zaheer Nabi, Duvuur Nageshwar Reddy
International Journal of Gastrointestinal Intervention.2020; 9(2): 67. CrossRef
Peroral Endoscopic Myotomy, a Well-Established, Efficacious, and Safe Treatment Option for Achalasia: Is the History of Previous Treatment a Hurdle or Not?
Young Hoon Youn
Clinical Endoscopy.2020; 53(3): 247. CrossRef

8,273 View
148 Download
9 Web of Science
9 Crossref

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