Efficacy and Safety of Peroral Endoscopic Myotomy for Treatment of Achalasia After Failed Heller Myotomy

Saowanee Ngamruengphong, Haruhiro Inoue, Michael B. Ujiki, Lava Y. Patel, Amol Bapaye, Pankaj N. Desai, Shivangi Dorwat, Jun Nakamura, Yoshitaka Hata, Valerio Balassone, Manabu Onimaru, Thierry Ponchon, Mathieu Pioche, Sabine Roman, Jérôme Rivory, François Mion, Aurélien Garros, Peter V. Draganov, Yaseen Perbtani, Ali AbbasDavinderbir Pannu, Dennis Yang, Silvana Perretta, John Romanelli, David Desilets, Bu Hayee, Amyn Haji, Gulara Hajiyeva, Amr Ismail, Yen I. Chen, Majidah Bukhari, Yamile Haito-Chavez, Vivek Kumbhari, Payal Saxena, Michael Talbot, Philip Wai yan Chiu, Hon Chi Yip, Vivien Wai Yin Wong, Ruben Hernaez, Roberta Maselli, Alessandro Repici, Mouen A. Khashab

Research output: Contribution to journalArticlepeer-review


Background & Aims In patients with persistent symptoms after Heller myotomy (HM), treatment options include repeat HM, pneumatic dilation, or peroral endoscopic myotomy (POEM). We evaluated the efficacy and safety of POEM in patients with achalasia with prior HM vs without prior HM. Methods We conducted a retrospective cohort study of 180 patients with achalasia who underwent POEM at 13 tertiary centers worldwide, from December 2009 through September 2015. Patients were divided into 2 groups: those with prior HM (HM group, exposure; n = 90) and those without prior HM (non-HM group; n = 90). Clinical response was defined by a decrease in Eckardt scores to 3 or less. Adverse events were graded according to criteria set by the American Society for Gastrointestinal Endoscopy. Technical success, clinical success, and rates of adverse events were compared between groups. Patients were followed up for a median of 8.5 months. Results POEM was technically successful in 98% of patients in the HM group and in 100% of patients in the non-HM group (P =.49). A significantly lower proportion of patients in the HM group had a clinical response to POEM (81%) than in the non-HM group (94%; P =.01). There were no significant differences in rates of adverse events between the groups (8% in the HM group vs 13% in the non-HM group; P =.23). Symptomatic reflux and reflux esophagitis after POEM were comparable between groups. Conclusions POEM is safe and effective for patients with achalasia who were not treated successfully by prior HM. Although the rate of clinical success in patients with prior HM is lower than in those without prior HM, the safety profile of POEM is comparable between groups.

Original languageEnglish (US)
Pages (from-to)1531-1537.e3
JournalClinical Gastroenterology and Hepatology
Issue number10
StatePublished - Oct 2017


  • Achalasia
  • Heller Myotomy
  • Outcome
  • Peroral Endoscopic Myotomy
  • Recurrence
  • Surgery
  • Therapy

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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