Is POEM an Option for Achalasia After Failed Heller Myotomy?

Yes, based on a series of successful peroral endoscopic myotomy procedures performed by a skilled operator.

Recent recommendations by esophageal experts have positioned peroral endoscopic myotomy (POEM) as a safe and effective option for patients with achalasia. However, those experts caution that dissection might be more challenging with prior failed Heller myotomy (HM; NEJM JW Gastroenterol 2017 Nov 2; [e-pub] and Gastroenterology 2017; 153:1205).

In a single-center analysis, researchers evaluated the safety and efficacy of 318 consecutive POEM procedures performed by one operator, comparing outcomes between 46 procedures done in patients with prior failed HM and all others. Contraindications were uncorrectable coagulopathy, severe lung disease requiring supplemental oxygen, steroid dependence, and expected survival <12 months.

The clinical succe…

Reviewing Author

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors