Long-term (3-year) composite gastroesophageal reflux outcomes of peroral endoscopic myotomy with or without concomitant endoscopic fundoplication in matched cohorts of achalasia.

BACKGROUND AND AIMS

Peroral endoscopic myotomy (POEM) is well established for the treatment of achalasia. Post-POEM gastroesophageal reflux (GER) has been identified as a concern. Concomitant endoscopic fundoplication (POEM + F) may reduce post-POEM GER. This study compares composite (objective and subjective) GER outcomes at 3 years' follow-up in a matched cohort of patients with achalasia undergoing POEM versus POEM + F.

METHODS

This single-center, retrospective, matched cohort study compared POEM + F versus POEM. It used retrospective matching with criteria as follows: age, sex, body mass index, achalasia type, prior interventions, and American Society of Anesthesiologists status. Baseline characteristics, pre/postprocedure Eckardt scores (ESs), technical aspects, and AEs were recorded. Both groups were followed up annually for 3 years. Outcomes were compared at 3 years. The primary outcome was the incidence of objective GER (Lyon Consensus 2.0); and secondary outcomes were subjective (symptomatic) GER (GERD questionnaire, Reflux Symptom Index, GERD health-related quality of life), and clinical success (ES <3). P < .05 was considered significant.

RESULTS

Thirty-four POEM + F patients were matched to 34 POEM patients (total consecutive POEM + F = 41; excluded = 7 [technical failure, = 2; unsuitable match, = 5]). AEs included mucosal injury (POEM vs POEM-F, 11.8% vs 8.8%; P = .69). One recurrence (POEM + F) at 9 months was excluded for long-term follow-up. At the 3-year follow-up, objective GER (esophageal acid exposure time >6% and/or Grade B or higher esophagitis) was observed in 2 (13.3%) of 15 patients (POEM + F) versus 7 (58.3%) of 12 (POEM) (P = .037). Wrap integrity was maintained in 76.5% of POEM + F cases at 3 years. Symptomatic GER (symptom scores) was low and comparable in both groups. Clinical success (ES <3) was sustained in all except 1 patient with recurrence (98.5%).

CONCLUSIONS

In a retrospective matched cohort, GER was significantly less frequent after POEM + F than only POEM, and wrap integrity was maintained in three-fourths of patients at the 3-year follow-up.