Comparison of peroral endoscopic myotomy between de-novo achalasia and achalasia with prior treatment

Abstract

Peroral endoscopic myotomy has been recognized as an effective treatment for patients with achalasia. Prior treatment may affect the outcome of subsequent treatment. We aimed to compare the safety and efficacy of POEM in treatment-naive patients vs. those with prior treatment failure. We retrospectively analyzed the data of achalasia patients who underwent POEM from November 2011 to January 2018. A comparative analysis was performed between De-Novo (DN) and Prior Treatment Failure (PTF) cases. Technical and clinical success, adverse events, operative time for POEM, hospital stay were compared between the two groups Overall, 209 patients with achalasia underwent POEM during the studied period, including 113 patients (54%) in the DN group and 96 patients (45%) in the PTF group. The baseline characteristics of the DN and PTF groups were not significantly different except for duration of disease. The PTF group had longer disease duration than the DN group. (7.92 +/- 9.28 vs 4.45 +/- 5.67 years, respectively, p = 0.005). Both groups were technically successful. Operative time was longer in the PTF group than that in the de-novo group, but the difference was not significant. The occurrence rates of complications were similar in both groups. Changes in the Eckardt score were comparable in the DN and PTF cases. IRP and LES pressure decreased after POEM. After 6 months, more patients suffered from reflux symptoms in the PTF group, but DeMeester score and endoscopic evaluation were not significantly different POEM is safe and equally effective for patients with prior treatment failure as well as de-novo patients up to 6 months post treatment.