Gastroesophageal Reflux after Peroral Endoscopic Myotomy: Myth or Reality?
Peroral endoscopic myotomy (POEM) is an accepted treatment for achalasia cardia (AC), and results are comparable to those of laparoscopic Heller myotomy (LHM). In recent years, several reports have confirmed higher incidence of gastroesophageal reflux (GER) following POEM. This review evaluates the...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2021-12-01
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| Series: | Journal of Digestive Endoscopy |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1740489 |
| _version_ | 1798022129868865536 |
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| author | Amol Bapaye Ashish Gandhi Jay Bapaye |
| author_facet | Amol Bapaye Ashish Gandhi Jay Bapaye |
| author_sort | Amol Bapaye |
| collection | DOAJ |
| description | Peroral endoscopic myotomy (POEM) is an accepted treatment for achalasia cardia (AC), and results are comparable to those of laparoscopic Heller myotomy (LHM). In recent years, several reports have confirmed higher incidence of gastroesophageal reflux (GER) following POEM. This review evaluates the current evidence regarding post-POEM GER, critically examines the potential contributing factors responsible for GER, limitations of the current available functional testing, and precautions and preventive measures, and provides future directions for research. Factors conclusively contributing to increased post-POEM GER include injury to the sling fibers of the lower esophageal sphincter, length of gastric myotomy > 2 cm, and others. Historically, these same factors have been implicated for development of GER after surgical (laparoscopic) myotomy. Although less invasive, optimal technique of POEM may be important to control post-POEM GER. Most post-POEM GER occurs during the immediate post-POEM period, is mild, and is easily treatable using proton-pump inhibitors. GER incidence plateaus at 2 years and is comparable to that after LHM. Patients should therefore be prescribed proton-pump inhibitors for at least 2 years. Antireflux procedures (ARPs) are infrequently required in these patients as the incidence of refractory GER is low. Novel ARPs have been recently described and are currently under evaluation. Conclusive diagnosis of GER is a clinical challenge. Most patients are asymptomatic, and GER is diagnosed only on abnormal esophageal acid exposure (EAE). Studies have demonstrated that current measures to diagnose GER are inadequate, inaccurate, and cannot differentiate between true GER and abnormal EAE due to food fermentation in the distal esophagus. The Lyon Consensus criteria should be implemented for confirmation of diagnosis of GER. Finally, the review recommends an evidence-based clinical algorithm for evaluation and management of post-POEM GER and provides guidelines for future research in this field. |
| first_indexed | 2024-04-11T17:24:49Z |
| format | Article |
| id | doaj.art-acd3bbc776f649a0a5bb7c4a7dd2ed4a |
| institution | Directory Open Access Journal |
| issn | 0976-5042 0976-5050 |
| language | English |
| last_indexed | 2024-04-11T17:24:49Z |
| publishDate | 2021-12-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Journal of Digestive Endoscopy |
| spelling | doaj.art-acd3bbc776f649a0a5bb7c4a7dd2ed4a2022-12-22T04:12:22ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Digestive Endoscopy0976-50420976-50502021-12-01120420221310.1055/s-0041-1740489Gastroesophageal Reflux after Peroral Endoscopic Myotomy: Myth or Reality?Amol Bapaye0Ashish Gandhi1Jay Bapaye2Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, IndiaShivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, IndiaDepartment of Internal Medicine, Rochester General Hospital, Rochester, New York, United StatesPeroral endoscopic myotomy (POEM) is an accepted treatment for achalasia cardia (AC), and results are comparable to those of laparoscopic Heller myotomy (LHM). In recent years, several reports have confirmed higher incidence of gastroesophageal reflux (GER) following POEM. This review evaluates the current evidence regarding post-POEM GER, critically examines the potential contributing factors responsible for GER, limitations of the current available functional testing, and precautions and preventive measures, and provides future directions for research. Factors conclusively contributing to increased post-POEM GER include injury to the sling fibers of the lower esophageal sphincter, length of gastric myotomy > 2 cm, and others. Historically, these same factors have been implicated for development of GER after surgical (laparoscopic) myotomy. Although less invasive, optimal technique of POEM may be important to control post-POEM GER. Most post-POEM GER occurs during the immediate post-POEM period, is mild, and is easily treatable using proton-pump inhibitors. GER incidence plateaus at 2 years and is comparable to that after LHM. Patients should therefore be prescribed proton-pump inhibitors for at least 2 years. Antireflux procedures (ARPs) are infrequently required in these patients as the incidence of refractory GER is low. Novel ARPs have been recently described and are currently under evaluation. Conclusive diagnosis of GER is a clinical challenge. Most patients are asymptomatic, and GER is diagnosed only on abnormal esophageal acid exposure (EAE). Studies have demonstrated that current measures to diagnose GER are inadequate, inaccurate, and cannot differentiate between true GER and abnormal EAE due to food fermentation in the distal esophagus. The Lyon Consensus criteria should be implemented for confirmation of diagnosis of GER. Finally, the review recommends an evidence-based clinical algorithm for evaluation and management of post-POEM GER and provides guidelines for future research in this field.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1740489peroral endoscopic myotomygastroesophageal refluxpost-poem gergastrointestinal reflux disease |
| spellingShingle | Amol Bapaye Ashish Gandhi Jay Bapaye Gastroesophageal Reflux after Peroral Endoscopic Myotomy: Myth or Reality? Journal of Digestive Endoscopy peroral endoscopic myotomy gastroesophageal reflux post-poem ger gastrointestinal reflux disease |
| title | Gastroesophageal Reflux after Peroral Endoscopic Myotomy: Myth or Reality? |
| title_full | Gastroesophageal Reflux after Peroral Endoscopic Myotomy: Myth or Reality? |
| title_fullStr | Gastroesophageal Reflux after Peroral Endoscopic Myotomy: Myth or Reality? |
| title_full_unstemmed | Gastroesophageal Reflux after Peroral Endoscopic Myotomy: Myth or Reality? |
| title_short | Gastroesophageal Reflux after Peroral Endoscopic Myotomy: Myth or Reality? |
| title_sort | gastroesophageal reflux after peroral endoscopic myotomy myth or reality |
| topic | peroral endoscopic myotomy gastroesophageal reflux post-poem ger gastrointestinal reflux disease |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1740489 |
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