Incidence and risk factors of reflux esophagitis after peroral endoscopic myotomy

• Published in: Neurogastroenterology and motility Vol. 36; no. 6; pp. e14794 - n/a
• Main Authors: Wessels, Elise M., Masclee, Gwen M. C., Bastiaansen, Barbara A. J., Fockens, Paul, Bredenoord, Albert J.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-06-2024
• Subjects: Achalasia; Endoscopy; Esophagitis; Gastroesophageal reflux; Laparoscopy; peroral endoscopic myotomy; predictive factors; reflux esophagitis; Risk factors; peroral endoscopic myotomy; reflux esophagitis; achalasia; gastroesophageal reflux; predictive factors
• ISSN: 1350-1925; 1365-2982
• DOI: 10.1111/nmo.14794

Background
Peroral endoscopic myotomy (POEM) is an effective and safe treatment for achalasia, but often leads to posttreatment gastroesophageal reflux disease. The aim of this study was to examine the incidence and severity of reflux esophagitis after POEM and to identify associated predictive factors.
Methods
Patients who underwent POEM between August 2011 and December 2022 were included. Multivariate logistic regression was used to assess predictive factors for reflux esophagitis after POEM.
Key Results
In total, 252 patients were included; of which, 46% were female and age ranged between 18 and 87 years. Reflux esophagitis within 1 year after POEM was observed in 131 patients (52%), which was severe in 29 patients (LA grade C/D, 12%). Length of full‐thickness myotomy (cm; OR 1.11, 95% CI 1.02–1.21), Eckardt scores before POEM (OR 0.84, 95% CI 0.74–0.96), previous pneumatic dilation (OR 0.51, 95% CI 0.29–0.91), and previous laparoscopic Heller myotomy (LHM; OR 0.44, 95% CI 0.23–0.86) were associated with reflux esophagitis after POEM. Alcohol use (none vs > 7 units per week; OR 3.51, 95% CI 1.35–9.11) and overweight (BMI ≥25 kg/m2; OR 2.67, 95% CI 1.17–6.09) were positive predictive factors and previous LHM (OR 0.13, 95% CI 0.02–0.95) was a negative predictive factor for severe reflux esophagitis after POEM (LA grade C/D).
Conclusion
About half of the patients develop reflux esophagitis after POEM and 12% is graded as severe. Recognizing predictive factors of reflux esophagitis after POEM treatment leads to better patient selection before POEM and provides an opportunity to take preventive measures or start preemptive treatment.
Reflux esophagitis is commonly observed within 1 year after peroral endoscopic myotomy (POEM) and is severe (grade C/D) in 1 out of 10 patients. Recognizing risk factors for reflux esophagitis after POEM is imperative to select patients for POEM and to take appropriate preventive measures.