Peroral endoscopic myotomy as salvation technique post-Heller: International experience

Amy Tyberg, Reem Z. Sharaiha, Pietro Familiari, Guido Costamagna, Fernando Casas, Nikhil A. Kumta, Maximilien Barret, Amit P. Desai, Felice Schnoll-Sussman, Payal Saxena, Guadalupe Martínez, Felipe Zamarripa, Monica Gaidhane, Helga Bertani, Peter V. Draganov, Valerio Balassone, Ahmed Sharata, Kevin Reavis, Lee Swanstrom, Martina InvernizziStefan Seewald, Hitomi Minami, Haruhiro Inoue, Michel Kahaleh

Research output: Contribution to journalArticlepeer-review

49 Scopus citations


Background: Treatment for achalasia has traditionally been Heller myotomy (HM). Despite its excellent efficacy rate, a number of patients remain symptomatic post-procedure. Limited data exist as to the best management for recurrence of symptoms post-HM. We present an international, multicenter experience evaluating the efficacy and safety of post-HM peroral endoscopic myotomy (POEM). Methods: Patients who underwent POEM post-HM from 13 centers from January 2012 to January 2017 were included as part of a prospective registry. Technical success was defined as successful completion of the myotomy. Clinical success was defined as an Eckardt score of ≤3 on 12-month follow up. Adverse events (AE) including anesthesia-related, operative, and postoperative complications were recorded. Results: Fifty-one patients were included in the study (mean age 54.2, 47% male). Technical success was achieved in 100% of patients. Clinical success on long-term follow up was achieved in 48 patients (94%), with a mean change in Eckardt score of 6.25. Seven patients (13%) had AE: six experienced periprocedural mucosal defect treated endoscopically and two patients developed mediastinitis treated conservatively. Conclusion: For patients with persistent symptoms after HM, POEM is a safe salvation technique with good short-term efficacy. As a result of the challenge associated with repeat HM, POEM might become the preferred technique in this patient population. Further studies with longer follow up are needed.

Original languageEnglish
Pages (from-to)52-56
Number of pages5
JournalDigestive Endoscopy
Issue number1
StatePublished - Jan 2018
Externally publishedYes


  • Heller myotomy
  • achalasia
  • endoscopy
  • esophagus
  • peroral endoscopic myotomy (POEM)


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