Varan Perananthan, Lucy Bracken, Andrea Huang, Fiona Jones, Francesco Vito Mandarino, Brian Lam, Julia Gauci, Clarence Kerrison, Sunil Gupta, Anthony Whitfield, Nicholas Burgess, Spiro Raftopoulos, Bronte A Holt, Luke F Hourigan, Michael J Bourke
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引用次数: 0
Abstract
Background: Peroral endoscopic myotomy (POEM) is an established treatment for achalasia, achieving >90% short-term clinical success. However, long-term durability remains less clear. This study evaluates POEM outcomes beyond 5 years in a multi-centre cohort.
Aims: This study evaluates POEM outcomes beyond 5 years in a multi-centre cohort.
Methods: Patients with achalasia who underwent POEM across four Australian tertiary centres (January 2014-January 2020) were prospectively enrolled. Eckardt scores were recorded pre-treatment and at multiple intervals up to ≥5 years after POEM. Primary outcome was clinical success at ≥5 years, defined as Eckardt score ≤3 without need for re-intervention. Secondary outcomes included risk factors for failure and management strategies.
Results: Of 221 eligible patients, 153 (69.2%) had ≥5-year follow-up data available, with median follow-up of 6.5 years (interquartile range (IQR) 5.6-7.6). Achalasia subtypes included type I (23.5%), type II (62.1%) and type III (14.4%). Among the patients, 52.3% were treatment-naïve; prior therapies included laparoscopic Heller myotomy (14.3%), botulinum toxin (17.0%) and pneumatic balloon dilation (30.7%). Clinical success at ≥5 years was observed in 118 (77.1%) patients. Median Eckardt scores improved from 8.0 (IQR 6.0-10.0) before POEM to 0.0 (IQR 0.0-1.0) at 3-6 months, 1.0 (IQR 0.0-2.0) at 2 years and 2.0 (IQR 0.0-3.0) at 5 years. Sustained success was associated with lower baseline Eckardt scores (P = 0.033). Prior lower oesophageal sphincter (LOS)-directed therapy predicted failure (odds ratio 3.80, P < 0.001). Age, achalasia subtype, myotomy characteristics and post-POEM endoscopy findings were not predictive.
Conclusion: POEM provides durable symptom relief beyond 5 years for achalasia. Higher pre-POEM symptom burden and prior LOS-directed interventions are associated with reduced long-term success.
期刊介绍：
The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.
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