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GERD after Peroral Endoscopic Myotomy: Assessment of Incidence and Predisposing Factors
Journal article   Peer reviewed

GERD after Peroral Endoscopic Myotomy: Assessment of Incidence and Predisposing Factors

Mohamad Rassoul Abu-Nuwar, Sven E Eriksson, Inanc S Sarici, Ping Zheng, Toshitaka Hoppo, Blair A Jobe and Shahin Ayazi
Journal of the American College of Surgeons, v 236(1), pp 58-70
01 Jan 2023
DOI: https://doi.org/10.1097/XCS.0000000000000448
PMID: 36519909
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1097/XCS.0000000000000448View
Published, Version of Record (VoR) Restricted

Abstract

Causality Esophageal Achalasia - diagnosis Esophageal Sphincter, Lower - surgery Esophagitis - complications Esophagoscopy - methods Female Gastroesophageal Reflux - epidemiology Gastroesophageal Reflux - etiology Gastroesophageal Reflux - surgery Humans Incidence Myotomy - adverse effects Myotomy - methods Natural Orifice Endoscopic Surgery - adverse effects Natural Orifice Endoscopic Surgery - methods Treatment Outcome
Peroral endoscopic myotomy (POEM) is an effective intervention for achalasia, but GERD is a major postoperative adverse event. This study aimed to characterize post-POEM GERD and identify preoperative or technical factors impacting development or severity of GERD. This is a retrospective review of patients who underwent POEM at our institution. Favorable outcome was defined as postoperative Eckardt score of 3 or less. Subjective GERD was defined as symptoms consistent with reflux. Objective GERD was based on a DeMeester score greater than 14.7 or Los Angeles grade C or D esophagitis. Severe GERD was defined as a DeMeester score greater than 50.0 or Los Angeles grade D esophagitis Preoperative clinical and objective data and technical surgical elements were compared between those with and without GERD. Multivariate logistic analysis was performed to identify factors associated with each GERD definition. A total of 183 patients underwent POEM. At a mean ± SD follow-up of 21.7 ± 20.7 months, 93.4% achieved favorable outcome. Subjective, objective, and severe objective GERD were found in 38.8%, 50.5%, and 19.2% of patients, respectively. Of those with objective GERD, 24.0% had no reflux symptoms. Women were more likely to report GERD symptoms (p = 0.007), but objective GERD rates were similar between sexes (p = 0.606). The independent predictors for objective GERD were normal preoperative diameter of esophagus (odds ratio [OR] 3.4; p = 0.008) and lower esophageal sphincter (LES) pressure less than 45 mmHg (OR 1.86; p = 0.027). The independent predictors for severe objective GERD were LES pressure less than 45 mmHg (OR 6.57; p = 0.007) and obesity (OR 5.03; p = 0.005). The length of esophageal or gastric myotomy or indication of procedure had no impact on the incidence or severity of GERD. The rate of pathologic GERD after POEM is higher than symptomatic GERD. A nonhypertensive preoperative LES is a predictor for post-POEM GERD. No modifiable factors impact GERD after POEM.

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19 citations in Web of Science
17 citations in Scopus

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UN Sustainable Development Goals (SDGs)

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Surgery
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