AI Article Synopsis
- Laparoscopic fundoplication can effectively treat GERD but may lead to severe swallowing difficulties in some patients (5%-10% incidence).
- A study examined the use of peroral endoscopic myotomy (POEM) alongside valve incision to address these swallowing issues, with a focus on treatment outcomes and any complications.
- Results showed a high success rate (96% technical, 84.6% clinical) in 26 patients, with a few cases of GERD recurrence that were manageable with medication.
Article Abstract
Background And Aims: The use of laparoscopic fundoplication (LF) to treat refractory GERD may induce refractory dysphagia (5%-10%). The management is complex, and peroral endoscopic myotomy (POEM) including valve incision is a new therapeutic option.
Methods: This retrospective study involved patients with postfundoplication refractory dysphagia treated by POEM associated with complete wrap incision. Patients were evaluated with Eckardt and dysphagia scores. Study objectives were to evaluate clinical and technical outcomes, adverse events, and GERD recurrence.
Results: Twenty-six patients, with a mean age of 57.3 ± 15.6 years, were included. Mean follow-up was 25.3 ± 17.6 months. The technical and clinical success rates were 96% and 84.6%, respectively. Among failures, 1 patient underwent Lewis-Santy, 2 required dilations, and 1 was lost to follow-up. Three late recurrences occurred and were endoscopically managed. Five patients (19%) had GERD recurrence that was mainly improved by proton pump inhibitors.
Conclusions: POEM with fundoplication is a serious therapeutic option for managing persistent dysphagia after LF, with a low risk of GERD recurrence.
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| http://dx.doi.org/10.1016/j.gie.2023.06.027 | DOI Listing |
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