Statement for gastroesophageal reflux disease after peroral endoscopic myotomy from an international multicenter experience

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Abstract

It has been 10 years since peroral endoscopic myotomy (POEM) was reported for the first time, and POEM has currently become the standard treatment for achalasia and related disorders globally because it is less invasive and has a higher curative effect than conventional therapeutic methods. However, there are limited studies comparing the long-term outcomes of POEM with those of conventional therapeutic methods, particularly in the occurrence of gastroesophageal reflux disease (GERD) after therapy. With this background, we held a consensus meeting to discuss the pathophysiology and management of GERD after POEM based on published papers and experiences of each expert and to discuss the prevention of GERD and dealing with anti-acid drug refractory GERD. This meeting was held on April 27, 2018 in Tokyo to establish statements and finalize the recommendations using the modified Delphi method. This manuscript presents eight statements regarding GERD after POEM.

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Most cited references 17

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Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization.

Marcus Overhage, Richard Shiffman, Jeremy M. Grimshaw … (2003)

Despite enormous energies invested in authoring clinical practice guidelines, the quality of individual guidelines varies considerably. The Conference on Guideline Standardization (COGS) was convened in April 2002 to define a standard for guideline reporting that would promote guideline quality and facilitate implementation. Twenty-three people with expertise and experience in guideline development, dissemination, and implementation participated. A list of candidate guideline components was assembled from the Institute of Medicine Provisional Instrument for Assessing Clinical Guidelines, the National Guideline Clearinghouse, the Guideline Elements Model, and other published guideline models. In a 2-stage modified Delphi process, panelists first rated their agreement with the statement that "[Item name] is a necessary component of practice guidelines" on a 9-point scale. An individualized report was prepared for each panelist; the report summarized the panelist's rating for each item and the median and dispersion of rankings of all the panelists. In a second round, panelists separately rated necessity for validity and necessity for practical application. Items achieving a median rank of 7 or higher on either scale, with low disagreement index, were retained as necessary guideline components. Representatives of 22 organizations active in guideline development reviewed the proposed items and commented favorably. Closely related items were consolidated into 18 topics to create the COGS checklist. This checklist provides a framework to support more comprehensive documentation of practice guidelines. Most organizations that are active in guideline development found the component items to be comprehensive and to fit within their existing development methods.

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Laparoscopic Heller Myotomy Versus Peroral Endoscopic Myotomy (POEM) for Achalasia: A Systematic Review and Meta-analysis.

Francisco Schlottmann, Daniel Luckett, Jason Fine … (2017)

To compare the outcome of per oral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) for the treatment of esophageal achalasia.

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Peroral endoscopic myotomy: a meta-analysis.

Emmanuel Akintoye, Nitin Kumar, Itegbemie Obaitan … (2016)

Background and study aim: Peroral endoscopic myotomy (POEM) is a relatively novel minimally invasive technique that is used to treat achalasia and other esophageal motility disorders. We systematically reviewed the medical literature in order to evaluate the safety and efficacy of POEM. Methods: We performed a comprehensive review and meta-analysis of studies published up to March 2016 that reported on clinical outcomes of POEM. Five databases were searched: MEDLINE, EMBASE, Ovid, CINAHL, and Cochrane. Results: A total of 36 studies involving 2373 patients were included in the review. Clinical success (Eckardt score ≤ 3) was achieved in 98 % (95 % confidence interval [CI] 97 % - 100 %) of patients after the procedure. The mean Eckardt score decreased from 6.9 ± 0.15 preoperatively to 0.77 ± 0.10, 1.0 ± 0.10, and 1.0 ± 0.08 within 1, 6, and 12 months of treatment. In addition, there were significant decreases in the average lower esophageal sphincter pressure, integrated relaxation pressure, and the average heights of the barium column following a timed barium esophagogram after the procedure. After a mean follow-up of 8 months post-procedure, the rates of symptomatic gastroesophageal reflux, esophagitis on esophagogastroduodenoscopy, and abnormal acid exposure were 8.5 % (95 %CI 4.9 % - 13 %), 13 % (95 %CI 5.0 % - 23 %), and 47 % (95 %CI 21 % - 74 %), respectively. Conclusions: POEM appears to be safe and effective based on the large body of current evidence, and warrants consideration as first-line therapy when an expert operator is available.

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Author and article information

Contributors

Haruhiro Inoue: haruinoue777@yahoo.co.jp

Hironari Shiwaku:

ORCID: http://orcid.org/0000-0002-8435-3668

hiro.shiwaku@gmail.com

Journal

Journal ID (nlm-ta): Esophagus

Journal ID (iso-abbrev): Esophagus

Title: Esophagus

Publisher: Springer Singapore (Singapore )

ISSN (Print): 1612-9059

ISSN (Electronic): 1612-9067

Publication date (Electronic): 26 September 2019

Publication date PMC-release: 26 September 2019

Publication date (Print): 2020

Volume: 17

Issue: 1

Pages: 3-10

Affiliations

[1 ]GRID grid.410714.7, ISNI 0000 0000 8864 3422, Digestive Diseases Center, , Showa University Koto-Toyosu Hospital, ; Toyosu 5-1-38, Koto-Ku, Tokyo, 135-8577 Japan

[2 ]GRID grid.411497.e, ISNI 0000 0001 0672 2176, Department of Gastroenterological Surgery, , Fukuoka University Faculty of Medicine, ; 7-45-1, Nanakuma, Jyonan-ku, Fukuoka, 814-0180 Japan

[3 ]GRID grid.410804.9, ISNI 0000000123090000, Department of Gastroenterology and Hepatology, , Jichi Medical University, ; Shimotsuke, Tochigi Japan

[4 ]The Institute of Digestive Disease, Faculty of Medicine of the Chinese University of Hong Kong, Hong Kong, China

[5 ]GRID grid.414935.e, ISNI 0000 0004 0447 7121, Center for Interventional Endoscopy, , Florida Hospital Orlando, ; Orlando, Florida USA

[6 ]GRID grid.492163.b, ISNI 0000 0000 8976 5894, Department of Internal Medicine, , Evangelisches Krankenhaus Düsseldorf, ; Düsseldorf, Germany

[7 ]GRID grid.8142.f, ISNI 0000 0001 0941 3192, Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, , Catholic University, ; Rome, Italy

[8 ]GRID grid.137628.9, ISNI 0000 0004 1936 8753, Division of Gastroenterology, Hepatology, and Nutrition, , NYU-Winthrop Hospital, ; New York, USA

[9 ]GRID grid.417468.8, ISNI 0000 0000 8875 6339, Division of Gastroenterology and Hepatology, , Mayo Clinic Arizona, ; Scottsdale, AZ USA

[10 ]GRID grid.417546.5, ISNI 0000 0004 0510 2882, Centre of Gastroenterology, , Klinik Hirslanden, ; Zurich, Switzerland

[11 ]GRID grid.174567.6, ISNI 0000 0000 8902 2273, Department of Gastroenterology and Hepatology, , Nagasaki University, ; Nagasaki, Japan

[12 ]GRID grid.31432.37, ISNI 0000 0001 1092 3077, Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, , Kobe University, ; Kobe, Japan

[13 ]Section of Gastroenterology and Digestive Endoscopy, De La Salle University Medical Center, Dasmarinas City, Philippines

[14 ]GRID grid.24827.3b, ISNI 0000 0001 2179 9593, Department of Surgery, , University of Cincinnati College of Medicine, ; Cincinnati, OH USA

[15 ]GRID grid.411898.d, ISNI 0000 0001 0661 2073, Department of Innovative Interventional Endoscopy Research, , The Jikei University School of Medicine, ; Tokyo, Japan

Author information

Hironari Shiwaku http://orcid.org/0000-0002-8435-3668

Article

Publisher ID: 689

DOI: 10.1007/s10388-019-00689-6

PMC ID: 6976544

PubMed ID: 31559513

SO-VID: 2440bef2-ee0c-478f-905d-2647cc856bd3

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 26 March 2019

Date accepted : 28 August 2019

Funding

Funded by: partially supported by educational grant from Olympus to Tokyo Live 2018

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ScienceOpen disciplines: Otolaryngology

Keywords: achalasia,gerd,myotomy

Data availability:

ScienceOpen disciplines: Otolaryngology

Keywords: achalasia, gerd, myotomy

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Statement for gastroesophageal reflux disease after peroral endoscopic myotomy from an international multicenter experience

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Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization.

Laparoscopic Heller Myotomy Versus Peroral Endoscopic Myotomy (POEM) for Achalasia: A Systematic Review and Meta-analysis.

Peroral endoscopic myotomy: a meta-analysis.

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