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Peroral endoscopic myotomy: 10-year outcomes from a large, single-center U.S. series with high follow-up completion and comprehensive analysis of long-term efficacy, safety, objective GERD, and endoscopic functional luminal assessment

Modayil, Rani J; Zhang, Xiaocen; Rothberg, Brooke; Kollarus, Maria; Galibov, Iosif; Peller, Hallie; Taylor, Sharon; Brathwaite, Collin E; Halwan, Bhawna; Grendell, James H; Stavropoulos, Stavros N
BACKGROUND AND AIMS/OBJECTIVE:Peroral endoscopic myotomy (POEM) is becoming the treatment of choice for achalasia. Data beyond 3 years are emerging but limited. We herein report our 10-year experience, focusing on long-term efficacy and safety including the prevalence, management, and sequelae of postoperative reflux. METHODS:This was a single-center prospective cohort study. RESULTS:Six hundred ten consecutive patients received POEM from October 2009 to October 2019 for type I achalasia in 160 (26.2%), II in 307 (50.3%), III in 93 (15.6%), untyped achalasia in 25 (4.1%), and nonachalasia disorders in 23 (3.8%). Two hundred ninety-two (47.9%) patients had prior treatment(s). There was no aborted POEM. Median operation time was 54 minutes. Accidental mucosotomies occurred in 64 (10.5%) and clinically significant adverse events (csAEs) in 21 (3.4%) patients. There were no adverse events (AEs) leading to death, surgery, interventional radiology interventions/drains, or altered functional status. At a median follow-up of 30 months, 29 failures occurred, defined as postoperative Eckardt score >3 or need for additional treatment. The Kaplan-Meier clinical success estimates at year 1, 2, 3, 4, 5, 6, and 7 were 98%, 96%, 96%, 94%, 92%, 91%, and 91%, respectively. These are highly accurate estimates because only 13 (2%) patients were missing follow-up assessments. One hundred twenty-five (20.5%) patients had reflux symptoms more than once per week. At a median of 4 months, the pH study was completed in 406 (66.6%) patients and was positive in 232 (57.1%) and endoscopy in 438 (71.8%) patients and showed reflux esophagitis in 218 (49.8%), mostly mild. CONCLUSION/CONCLUSIONS:POEM is exceptionally safe and highly effective on long-term follow-up, with >90% clinical success at ≥5 years.
PMID: 33989646
ISSN: 1097-6779
CID: 4867862


Stavropoulos, Stavros N.; Modayil, Rani J.; Zhang, Xiaocen; Khodorskiy, Dmitriy O.; Taylor, Sharon I.; Kollarus, Maria M.; Widmer, Jessica L.; Brathwaite, Collin E.; Peller, Abraham; Halwan, Bhawna; Friedel, David
ISSN: 0016-5107
CID: 3508502

Per-oral endoscopic myotomy in patients with or without prior Heller's myotomy: comparing long-term outcomes in a large U.S. single-center cohort (with videos)

Zhang, Xiaocen; Modayil, Rani J; Friedel, David; Gurram, Krishna C; Brathwaite, Collin E; Taylor, Sharon I; Kollarus, Maria M; Modayil, Sony; Halwan, Bhawna; Grendell, James H; Stavropoulos, Stavros N
BACKGROUND AND AIMS/OBJECTIVE:Heller's myotomy (HM) is one of the most effective treatments for esophageal achalasia. However, failures do exist, and the success rate tends to decrease with time. The efficacy of rescue treatments for patients with failed HM is limited. A few small-scale studies have reported outcomes of per-oral endoscopic myotomy (POEM) in these patients. We conducted this study to systematically assess feasibility, safety, and efficacy of POEM on patients who have had HM. METHODS:Patients at least 3 months out from POEM were selected from our prospective database: 318 consecutive POEMs performed from October 2009 to October 2016. The efficacy and safety of POEM were compared between the 46 patients with prior HM and the remaining 272 patients. RESULTS:Patients with prior HM had longer disease history, more advanced disease, more type I and less type II achalasia, lower before-POEM Eckardt scores, and lower before-POEM lower esophageal sphincter (LES) pressure (all P < .01). Procedure parameters and follow-up results (clinical success rate, Eckardt score, LES pressure, GERD score, esophagitis, and pH testing) showed no significant difference between the 2 groups. For the 46 HM-POEM patients, no clinically significant perioperative adverse events occurred. Their overall clinical success rate (Eckardt score ≤3 and no other treatment needed) was 95.7% at a median follow-up of 28 months. CONCLUSION/CONCLUSIONS:POEM as a rescue treatment for patients with achalasia who failed HM is feasible, safe, and highly effective. It should be the treatment of choice in managing these challenging cases at centers with a high level of experience with POEM.
PMID: 29122601
ISSN: 1097-6779
CID: 3035592

Cholesterol Crystal Embolization to the Kidney and to a Duodenal Leiomyoma

Sy, Alexander M; Vedula, Jogarao; Hanna, Iman; Halwan, Bhawna; Saitta, Patrick
Cholesterol crystal embolism can be spontaneous or iatrogenic, and it can involve any organ of the gastrointestinal tract, presenting with common gastrointestinal symptoms such as bleeding, perforation, obstruction, and inflammation. It is therefore considered the "great masquerader," requiring a high level of suspicion because the condition is associated with increased morbidity and mortality. We present a 69-year-old man who presented with gastrointestinal bleeding and azotemia. He was found to have cholesterol crystal embolization in the kidney and a duodenal leiomyoma, the latter being an uncommon site to embolize.
PMID: 30214911
ISSN: 2326-3253
CID: 3659032

A Case of Hirschsprung Disease in an Adult Male [Meeting Abstract]

Ballecer, Eric; Varghese, Bivin; Dao, Alexander; Ali, Mohammad F.; Halwan, Bhawna; Ajemian, Gregory; Yeghiayan, Paula
ISSN: 0002-9270
CID: 3508512

An Unusual Place to Land! Cholesterol Crystal Embolization to the Kidney and Duodenal Leiomyoma [Meeting Abstract]

Sy, Alexander; Vedula, Jogarao; Hanna, Iman; Halwan, Bhawna; Saitta, Patrick
ISSN: 0002-9270
CID: 3508522

Per Oral Endoscopic Myotomy (POEM) for Achalasia: Long-Term Outcomes Beyond 2 Years From a Large Prospective Single-Center Us Series [Meeting Abstract]

Stavropoulos, Stavros N.; Modayil, Rani J.; Brathwaite, Collin E.; Sy, Alexander; Ali, Mohammad F.; Taylor, Sharon I.; Halwan, Bhawna; Gurram, Krishna C.; Kollarus, Maria M.; Grendell, James H.
ISSN: 0016-5107
CID: 3508472

Peroral Endoscopic Myotomy (Poem) in Patients With or Without Prior Heller Myotomy: Comparing Long-Term Outcomes in a Large Us Single Center Cohort [Meeting Abstract]

Stavropoulos, Stavros N.; Zhang, Xiaocen; Modayil, Rani J.; Gurram, Krishna C.; Brathwaite, Collin E.; Taylor, Sharon I.; Halwan, Bhawna; Kollarus, Maria M.; Grendell, James H.
ISSN: 0016-5107
CID: 3508482

Anterior vs Posterior PerOral Endoscopic Myotomy (POEM): Is There a Difference in Outcomes? [Meeting Abstract]

Stavropoulos, Stavros N.; Modayil, Rani J.; Brathwaite, Collin; Halwan, Bhawna; Kollarus, Maria M.; Taylor, Sharon I.; Friedel, David; Grendell, James H.
ISSN: 0016-5107
CID: 3508452

Outcomes of a Large Prospective Series on Per Oral Endoscopic Myotomy (POEM) for Achalasia: An Effective and Durable Treatment Modality That Can Safely Be Performed in the Endoscopy Suite [Meeting Abstract]

Stavropoulos, Stavros N.; Modayil, Rani J.; Brathwaite, Collin; Halwan, Bhawna; Kollarus, Maria M.; Taylor, Sharon I.; Grendell, James H.
ISSN: 0016-5107
CID: 3508462