Management of patients after failed peroral endoscopic myotomy: A multicenter study

Yervant Ichkhanian; Daniella Assis; Pietro Familiari; Michael Ujiki; Baily Su; Sarah R. Khan; Mathieu Pioche; Peter V. Draganov; Joo Young Cho; Nikolas Eleftheriadis; Maximilien Barret; Amyn Haji; Vic Velanovich; Marcel Tantau; Jeffrey M. Marks; Amol Bapaye; Alireza Sedarat; Eduardo Albeniz; Robert Bechara; Nikhil A. Kumta; Guido Costamagna; Yaseen B. Perbtani; Mehul Patel; Megan Sippey; Sravan K. Korrapati; Rishabh Jain; Fermín Estremera; Mohamad H. El Zein; Olaya I. Brewer Gutierrez; Mouen A. Khashab

doi:10.1055/a-1312-0496

Management of patients after failed peroral endoscopic myotomy: A multicenter study

Yervant Ichkhanian, Daniella Assis, Pietro Familiari, Michael Ujiki, Baily Su, Sarah R. Khan, Mathieu Pioche, Peter V. Draganov, Joo Young Cho, Nikolas Eleftheriadis, Maximilien Barret, Amyn Haji, Vic Velanovich, Marcel Tantau, Jeffrey M. Marks, Amol Bapaye, Alireza Sedarat, Eduardo Albeniz, Robert Bechara, Nikhil A. KumtaGuido Costamagna, Yaseen B. Perbtani, Mehul Patel, Megan Sippey, Sravan K. Korrapati, Rishabh Jain, Fermín Estremera, Mohamad H. El Zein, Olaya I. Brewer Gutierrez, Mouen A. Khashab

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Abstract

Background Although peroral endoscopic myotomy (POEM) is highly effective for the management of achalasia, clinical failures may occur. The optimal management of patients who fail POEM is not well known. This study aimed to compare the outcomes of different management strategies in patients who had failed POEM. Methods This was an international multicenter retrospective study at 16 tertiary centers between January 2012 and November 2019.All patients who underwent POEM and experienced persistent or recurrent symptoms (Eckardt score>3) were included. The primary outcome was to compare the rates of clinical success (Eckardt score ≤3) between different management strategies. Results 99 patients (50 men [50.5%]; mean age 51.4 [standard deviation (SD) 16.2]) experienced clinical failure during the study period, with a mean (SD) Eckardt score of 5.4 (0.3). A total of 29 patients (32.2%) were managed conservatively and 70 (71%) underwent retreatment (repeat POEM 33 [33%], pneumatic dilation 30 [30%], and laparoscopic Heller myotomy (LHM) 7 [7.1%]). During a median follow-up of 10 (interquartile range 3-20) months, clinical success was highest in patients who underwent repeat POEM (25/33 [76%]; mean [SD] Eckardt score 2.1 [2.1]), followed by pneumatic dilation (18/30 [60%]; Eckardt score 2.8 [2.3]), and LHM (2/7 [29%]; Eckardt score 4 [1.8]; P =0.12). A total of 11 patients in the conservative group (37.9%; mean Eckardt score 4 [1.8]) achieved clinical success. Conclusion This study comprehensively assessed an international cohort of patients who underwent management of failed POEM. Repeat POEM and pneumatic dilation achieved acceptable clinical success, with excellent safety profiles.

Original language	English
Pages (from-to)	1003-1010
Number of pages	8
Journal	Endoscopy
Volume	53
Issue number	10
DOIs	https://doi.org/10.1055/a-1312-0496
State	Published - 21 Jan 2021

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Ichkhanian, Y., Assis, D., Familiari, P., Ujiki, M., Su, B., Khan, S. R., Pioche, M., Draganov, P. V., Cho, J. Y., Eleftheriadis, N., Barret, M., Haji, A., Velanovich, V., Tantau, M., Marks, J. M., Bapaye, A., Sedarat, A., Albeniz, E., Bechara, R., ... Khashab, M. A. (2021). Management of patients after failed peroral endoscopic myotomy: A multicenter study. Endoscopy, 53(10), 1003-1010. https://doi.org/10.1055/a-1312-0496

@article{81b2e19940af4a0db5fd50b8eb4437ab,

title = "Management of patients after failed peroral endoscopic myotomy: A multicenter study",

abstract = "Background Although peroral endoscopic myotomy (POEM) is highly effective for the management of achalasia, clinical failures may occur. The optimal management of patients who fail POEM is not well known. This study aimed to compare the outcomes of different management strategies in patients who had failed POEM. Methods This was an international multicenter retrospective study at 16 tertiary centers between January 2012 and November 2019.All patients who underwent POEM and experienced persistent or recurrent symptoms (Eckardt score>3) were included. The primary outcome was to compare the rates of clinical success (Eckardt score ≤3) between different management strategies. Results 99 patients (50 men [50.5%]; mean age 51.4 [standard deviation (SD) 16.2]) experienced clinical failure during the study period, with a mean (SD) Eckardt score of 5.4 (0.3). A total of 29 patients (32.2%) were managed conservatively and 70 (71%) underwent retreatment (repeat POEM 33 [33%], pneumatic dilation 30 [30%], and laparoscopic Heller myotomy (LHM) 7 [7.1%]). During a median follow-up of 10 (interquartile range 3-20) months, clinical success was highest in patients who underwent repeat POEM (25/33 [76%]; mean [SD] Eckardt score 2.1 [2.1]), followed by pneumatic dilation (18/30 [60%]; Eckardt score 2.8 [2.3]), and LHM (2/7 [29%]; Eckardt score 4 [1.8]; P =0.12). A total of 11 patients in the conservative group (37.9%; mean Eckardt score 4 [1.8]) achieved clinical success. Conclusion This study comprehensively assessed an international cohort of patients who underwent management of failed POEM. Repeat POEM and pneumatic dilation achieved acceptable clinical success, with excellent safety profiles.",

author = "Yervant Ichkhanian and Daniella Assis and Pietro Familiari and Michael Ujiki and Baily Su and Khan, {Sarah R.} and Mathieu Pioche and Draganov, {Peter V.} and Cho, {Joo Young} and Nikolas Eleftheriadis and Maximilien Barret and Amyn Haji and Vic Velanovich and Marcel Tantau and Marks, {Jeffrey M.} and Amol Bapaye and Alireza Sedarat and Eduardo Albeniz and Robert Bechara and Kumta, {Nikhil A.} and Guido Costamagna and Perbtani, {Yaseen B.} and Mehul Patel and Megan Sippey and Korrapati, {Sravan K.} and Rishabh Jain and Ferm{\'i}n Estremera and {El Zein}, {Mohamad H.} and {Brewer Gutierrez}, {Olaya I.} and Khashab, {Mouen A.}",

year = "2021",

month = jan,

day = "21",

doi = "10.1055/a-1312-0496",

language = "English",

volume = "53",

pages = "1003--1010",

journal = "Endoscopy",

issn = "0013-726X",

publisher = "Georg Thieme Verlag",

number = "10",

}

Ichkhanian, Y, Assis, D, Familiari, P, Ujiki, M, Su, B, Khan, SR, Pioche, M, Draganov, PV, Cho, JY, Eleftheriadis, N, Barret, M, Haji, A, Velanovich, V, Tantau, M, Marks, JM, Bapaye, A, Sedarat, A, Albeniz, E, Bechara, R, Kumta, NA, Costamagna, G, Perbtani, YB, Patel, M, Sippey, M, Korrapati, SK, Jain, R, Estremera, F, El Zein, MH, Brewer Gutierrez, OI & Khashab, MA 2021, 'Management of patients after failed peroral endoscopic myotomy: A multicenter study', Endoscopy, vol. 53, no. 10, pp. 1003-1010. https://doi.org/10.1055/a-1312-0496

TY - JOUR

T1 - Management of patients after failed peroral endoscopic myotomy

T2 - A multicenter study

AU - Ichkhanian, Yervant

AU - Assis, Daniella

AU - Familiari, Pietro

AU - Ujiki, Michael

AU - Su, Baily

AU - Khan, Sarah R.

AU - Pioche, Mathieu

AU - Draganov, Peter V.

AU - Cho, Joo Young

AU - Eleftheriadis, Nikolas

AU - Barret, Maximilien

AU - Haji, Amyn

AU - Velanovich, Vic

AU - Tantau, Marcel

AU - Marks, Jeffrey M.

AU - Bapaye, Amol

AU - Sedarat, Alireza

AU - Albeniz, Eduardo

AU - Bechara, Robert

AU - Kumta, Nikhil A.

AU - Costamagna, Guido

AU - Perbtani, Yaseen B.

AU - Patel, Mehul

AU - Sippey, Megan

AU - Korrapati, Sravan K.

AU - Jain, Rishabh

AU - Estremera, Fermín

AU - El Zein, Mohamad H.

AU - Brewer Gutierrez, Olaya I.

AU - Khashab, Mouen A.

PY - 2021/1/21

Y1 - 2021/1/21

N2 - Background Although peroral endoscopic myotomy (POEM) is highly effective for the management of achalasia, clinical failures may occur. The optimal management of patients who fail POEM is not well known. This study aimed to compare the outcomes of different management strategies in patients who had failed POEM. Methods This was an international multicenter retrospective study at 16 tertiary centers between January 2012 and November 2019.All patients who underwent POEM and experienced persistent or recurrent symptoms (Eckardt score>3) were included. The primary outcome was to compare the rates of clinical success (Eckardt score ≤3) between different management strategies. Results 99 patients (50 men [50.5%]; mean age 51.4 [standard deviation (SD) 16.2]) experienced clinical failure during the study period, with a mean (SD) Eckardt score of 5.4 (0.3). A total of 29 patients (32.2%) were managed conservatively and 70 (71%) underwent retreatment (repeat POEM 33 [33%], pneumatic dilation 30 [30%], and laparoscopic Heller myotomy (LHM) 7 [7.1%]). During a median follow-up of 10 (interquartile range 3-20) months, clinical success was highest in patients who underwent repeat POEM (25/33 [76%]; mean [SD] Eckardt score 2.1 [2.1]), followed by pneumatic dilation (18/30 [60%]; Eckardt score 2.8 [2.3]), and LHM (2/7 [29%]; Eckardt score 4 [1.8]; P =0.12). A total of 11 patients in the conservative group (37.9%; mean Eckardt score 4 [1.8]) achieved clinical success. Conclusion This study comprehensively assessed an international cohort of patients who underwent management of failed POEM. Repeat POEM and pneumatic dilation achieved acceptable clinical success, with excellent safety profiles.

AB - Background Although peroral endoscopic myotomy (POEM) is highly effective for the management of achalasia, clinical failures may occur. The optimal management of patients who fail POEM is not well known. This study aimed to compare the outcomes of different management strategies in patients who had failed POEM. Methods This was an international multicenter retrospective study at 16 tertiary centers between January 2012 and November 2019.All patients who underwent POEM and experienced persistent or recurrent symptoms (Eckardt score>3) were included. The primary outcome was to compare the rates of clinical success (Eckardt score ≤3) between different management strategies. Results 99 patients (50 men [50.5%]; mean age 51.4 [standard deviation (SD) 16.2]) experienced clinical failure during the study period, with a mean (SD) Eckardt score of 5.4 (0.3). A total of 29 patients (32.2%) were managed conservatively and 70 (71%) underwent retreatment (repeat POEM 33 [33%], pneumatic dilation 30 [30%], and laparoscopic Heller myotomy (LHM) 7 [7.1%]). During a median follow-up of 10 (interquartile range 3-20) months, clinical success was highest in patients who underwent repeat POEM (25/33 [76%]; mean [SD] Eckardt score 2.1 [2.1]), followed by pneumatic dilation (18/30 [60%]; Eckardt score 2.8 [2.3]), and LHM (2/7 [29%]; Eckardt score 4 [1.8]; P =0.12). A total of 11 patients in the conservative group (37.9%; mean Eckardt score 4 [1.8]) achieved clinical success. Conclusion This study comprehensively assessed an international cohort of patients who underwent management of failed POEM. Repeat POEM and pneumatic dilation achieved acceptable clinical success, with excellent safety profiles.

UR - http://www.scopus.com/inward/record.url?scp=85100294630&partnerID=8YFLogxK

U2 - 10.1055/a-1312-0496

DO - 10.1055/a-1312-0496

M3 - Article

C2 - 33197943

AN - SCOPUS:85100294630

SN - 0013-726X

VL - 53

SP - 1003

EP - 1010

JO - Endoscopy

JF - Endoscopy

IS - 10

ER -

Management of patients after failed peroral endoscopic myotomy: A multicenter study

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