← Back
Trans-C versus Cis-C thermally induced isomerisation of a terpyridine adduct of cytotoxic cycloruthenated compound
WJ G
World Journal of
Gastroenterology
Submit a Manuscript: https://www.f6publishing.com
World J Gastroenterol 2024 June 21; 30(23): 2947-2953
DOI: 10.3748/wjg.v30.i23.2947
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
EDITORIAL
Gastroesophageal reflux after per-oral endoscopic myotomy:
Management literature
Ahmed Tawheed, Ibrahim Halil Bahcecioglu, Mehmet Yalniz, Mohamed El-Kassas
Specialty type: Gastroenterology
and hepatology
Provenance and peer review:
Invited article; Externally peer
reviewed.
Peer-review model: Single blind
Peer-review report’s classification
Scientific Quality: Grade B, Grade
D, Grade D
Ahmed Tawheed, Mohamed El-Kassas, Department of Endemic Medicine, Faculty of Medicine,
Helwan University, Cairo 11795, Egypt
Ibrahim Halil Bahcecioglu, Mehmet Yalniz, Department of Gastroenterology, Faculty of
Medicine, Firat University, Elazig 23119, Türkiye
Mohamed El-Kassas, Liver Disease Research Center, College of Medicine, King Saud
University, Riyadh 7805, Saudi Arabia
Corresponding author: Mohamed El-Kassas, MD, Full Professor, Department of Endemic
Medicine, Faculty of Medicine, Helwan University, Ain Helwan, Cairo 11795, Egypt.
m_elkassas@yahoo.com
Novelty: Grade B, Grade C, Grade
D
Creativity or Innovation: Grade B,
Grade C, Grade D
Scientific Significance: Grade B,
Grade B, Grade C
P-Reviewer: Bortolotti M, Italy;
Wang D, China
Received: March 13, 2024
Revised: May 6, 2024
Accepted: May 20, 2024
Published online: June 21, 2024
Abstract
In this editorial, we respond to a review article by Nabi et al, in which the authors
discussed gastroesophageal reflux (GER) following peroral endoscopic myotomy
(POEM). POEM is presently the primary therapeutic option for achalasia, which is
both safe and effective. A few adverse effects were documented after POEM, including GER. The diagnostic criteria were not clear enough because approximately
60% of patients have a long acid exposure time, while only 10% experience reflux
symptoms. Multiple predictors of high disease incidence have been identified,
including old age, female sex, obesity, and a baseline lower esophageal sphincter
pressure of less than 45 mmHg. Some technical steps during the procedure, such
as a lengthy or full-thickness myotomy, may further enhance the risk. Proton
pump inhibitors are currently the first line of treatment. Emerging voices are
increasingly advocating for the routine combining of POEM with an endoscopic
fundoplication method, such as peroral endoscopic fundoplication or transoral
incisionless fundoplication. However, more research is necessary to determine the
safety and effectiveness of these procedures in the long term for patients who
have undergone them.
Key Words: Achalasia; Per-oral endoscopic myotomy; Gastroesophageal reflux disease;
Transoral incisionless fundoplication; Peroral endoscopic fundoplication
©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
WJG
https://www.wjgnet.com
2947
June 21, 2024
Volume 30
Issue 23
Tawheed A et al. Management of post-POEM GER
Core Tip: In this editorial, we discuss the current objective measures for diagnosing gastroesophageal reflux (GER) after
peroral endoscopic myotomy (POEM). We also review the factors that contribute to this adverse event, including patient and
technique-related characteristics. Furthermore, we provide a list of all published studies on the various treatment options
available for post-POEM GER, such as proton pump inhibitors, peroral endoscopic fundoplication, and transoral incisionless
fundoplication.
Citation: Tawheed A, Bahcecioglu IH, Yalniz M, El-Kassas M. Gastroesophageal reflux after per-oral endoscopic myotomy:
Management literature. World J Gastroenterol 2024; 30(23): 2947-2953
URL: https://www.wjgnet.com/1007-9327/full/v30/i23/2947.htm
DOI: https://dx.doi.org/10.3748/wjg.v30.i23.2947
INTRODUCTION
Achalasia is a disorder of esophageal motility. Its defining characteristics are the lower esophageal sphincter’s (LES)
ineffective relaxation and the absence of esophageal peristalsis[1]. Peroral endoscopic myotomy (POEM) is considered the
gold standard for managing achalasia[2]. After being introduced 16 years ago, we gained a better understanding of the
procedure, its long-term sequence, and its outcomes[3]. Despite the high safety profile of POEM procedures done by
third-space endoscopy experts, adverse events (AEs) are still reported. One of the notable AEs after POEM is gastroesophageal reflux (GER)[4]. In a meta-analysis, Repici et al[5] found that the incidence of GER was significantly higher
following POEM than laparoscopic Heller myotomy. In this editorial, we briefly discuss the predictors of post-POEM
GER and the different diagnostic and therapeutic strategies.
THE TRUTH ABOUT GERD
The Lyon consensus in 2018 determined that clinical history, questionnaire data, and response to antisecretory medication
are inadequate on their own to definitively diagnose GER disease (GERD)[6]. A definitive diagnosis could be made based
on the findings of objective tests. Endoscopic findings include grade C and D erosive esophagitis according to Los
Angeles classification (LA), a long segment of Barret’s esophagus, or strictures. At the same time, an acid exposure time
(AET) of > 6% is considered diagnostic along with the subjective methods. The consensus did not include recommendations for diagnosing post-POEM GER, despite multiple studies indicating a high prevalence of GER after POEM, with
rates as high as 60% in some instances[1,7,8]. Further clarification is needed regarding the term GER when describing the
sequelae in patients who have undergone POEM. Several post-POEM investigations characterize GER as having a
DeMeester score over 14.7 or an esophageal pH below 4 for over 5% of the observation period, similar to diagnosing GER
unrelated to POEM[1,9]. According to objective testing using 24-h pH monitoring, almost 50% of those individuals have a
high AET[10]. Despite the high incidence rate, only 10% of patients are symptomatic[9]. In those patients, a high AET can
be attributed to either real GER, characterized by an acute decrease in pH below 3 with sluggish clearance during pH
monitoring, or to fermentation of residual food due to long-standing achalasia, resulting in a gradual reduction in pH
usually above 3.7[11]. Diagnosis of GER using pH monitoring should be postponed for more than 1 mo following POEM
to prevent inaccurate results due to mucosal edema and damage[10].
PRECARIOUS PREDICTORS
Predicting GER after POEM has been challenging due to the lack of a standardized diagnostic approach, making it
difficult to rely on previous data. In 2021, a meta-analysis was conducted by Mota et al[12] on the published studies in the
literature discussing the risk factors for predicting the occurrence of GER after POEM. The study found that full-thickness
myotomy, using a posterior myotomy approach, endoscopic findings, pH monitoring, and symptoms were more commonly associated with GER. The authors recommended using circular and anterior myotomy to minimize the risk of
post-POEM GER. A study conducted by Wang et al[13] investigated the incidence of GERD in individuals who had
undergone POEM. The diagnosis of GERD was made based on abnormal acid exposure along with symptoms and/or
esophagitis. The study reported that patients who received a full-thickness myotomy had a higher likelihood of
developing GERD after POEM (37.5%) in comparison to those who underwent a selective myotomy (12.5%). However, in
another retrospective comparison study of 234 patients who underwent POEM, there was no significant difference in the
incidence of GER between the full-thickness and circular myotomy groups[14]. Other reported risk factors for post-POEM
GER include baseline LES pressure below 45 mmHg, obesity, female sex, and age over 65 years[1,7,15].
WJG
https://www.wjgnet.com
2948
June 21, 2024
Volume 30
Issue 23
Tawheed A et al. Management of post-POEM GER
IS PREVENTION BETTER THAN CURE?
The risk of post-POEM GER could be minimized during the procedure by some measures, including performing a short
esophageal myotomy[10]. In surgical myotomy procedures, myotomies shorter than 1 cm can reduce the occurrence of
GER, while myotomies longer than 2 cm have been shown to be more effective in relieving the symptoms of achalasia
[16]. A recent meta-analysis found that for patients who underwent POEM, the safety and effectiveness of short esophageal myotomy (ranging from 2.76 cm to 5 cm) was comparable to that of standard esophageal myotomy. Additionally,
the incidence rates of GER were similar in both groups; however, patients who received short myotomy treatment had a
lower risk of developing erosive esophagitis[17]. One method to determine the least effective length for endoscopic
myotomy is the double-scope technique, first introduced for POEM in 2016[18]. However, Grimes et al[19] conducted a
randomized controlled trial involving 100 patients, divided into two groups: Those who underwent a (2.6 cm) myotomy
with a single scope and those who underwent a longer myotomy (3.2 cm) with double scopes. The double-scope group
exhibited a greater incidence of moderate esophagitis LA grade B. Another reported measure was preserving gastric sling
muscle fibers during the procedure, as Shiwaku et al[20] demonstrated that it could be a safe way to reduce the incidence
of post-POEM GER with a 90% success rate. The two-vessel penetrating sign was initially proposed in 2018 by Tanaka et
al[21], it could serve as a useful indicator for identifying the myotomy’s endpoint.
Multiple studies have discussed the treatment strategies for post-POEM GER (Table 1). In a consensus, Inoue et al[22]
reported that proton pump inhibitors (PPIs) are the first line for treating post-POEM GER. The role of PPIs in patients
who underwent POEM is a bit controversial since most cases with high AET are asymptomatic[22]. According to studies,
the majority of patients who experienced symptoms of GER after POEM were effectively treated with PPIs, and the
response was confirmed using objective tests[23,24]. Although numerous algorithms have been suggested for treating
post-POEM GERD, Maydeo and Patil[10] presented the most comprehensive algorithm (Figure 1).
Figure 1 Algorithm of management of post-peroral endoscopic myotomy gastroesophageal reflux. The algorithm originally presented by Maydeo
and Patil[10] to manage post-peroral endoscopic myotomy (POEM) gastroesophageal reflux. However, we added the option of initial fundoplication with POEM to the
algorithm. EGD: Esophagogastroduodenoscopy; GERD: Gastroesophageal reflux disease; LA: Los Angeles; POEF: Peroral endoscopic fundoplication; PPI: Proton
pump inhibitor.
There is a debate surrounding the incorporation of endoscopic fundoplication as a standard procedure alongside
POEM. Multiple fundoplication approaches are being examined, either separate from POEM, such as transoral incisionless fundoplication (TIF)[25], or in combination with POEM, such as POEM with fundoplication (POEM + F)[26]. TIF
is a therapeutic endoscopic approach used to treat chronic GERD patients[27]. Since its introduction in 2006[28], several
studies have confirmed the viability of performing TIF following POEM[25,29-31]. Although most of these studies
involved small groups, they demonstrated a safe and effective procedure that led to patients discontinuing the use of PPIs
and resolving esophagitis.
The alternative fundoplication option is POEM + F. Inoue et al[26] introduced a novel endoscopic fundoplication to
reduce post-POEM GER. The authors documented a reduction in the incidence of reflux symptoms with an intact wrap at
1-mofollow-up after the procedure. In a single-center study, 25 patients underwent POEM + F, in which 23 patients (92%)
had a technically successful procedure. Follow-up endoscopy showed that 19 patients (82.6%) had an intact wrap,
whereas only 3 patients (12%) experienced delayed complications due to endoloop or endoclip erosion of the mucosa,
WJG
https://www.wjgnet.com
2949
June 21, 2024
Volume 30
Issue 23
Tawheed A et al. Management of post-POEM GER
Table 1 Studies reporting different treatment modalities for post-peroral endoscopic myotomy gastroesophageal reflux
Ref.
n
Treatment
Follow-up GER
assessment
method
Results and conclusion
Inoue et al[26],
2019
21
POEM + F
Not assessed
Technical success: 100%. Maintaining wrap at 2 mo: 95%. AE: 0%
Shrigiriwar et al
[33], 2023
6
POEM + F + PPI
GERD-HRQL; RSI
Technical success: 100%. AE: 0%. GERD-HRQL score: 2.3 ± 3.7. RSI Score:
2.2 ± 2.5
Patil et al[35],
2021
20
POEM + F + PPI
24 h pHmetry;
endoscopy
Technical success: 85%. Subcutaneous emphysema: 47%. Capnothorax:
17%. At 1 mo follow-up grade B esophagitis: 23.5%. At 3 mo pHmetry:
High AET in those with loosening of wrap 100%. At 3 mo pHmetry:
Normal AET in those who maintained wrap 100%. Maintaining wrap at 3
mo: 58.8%. Patient off PPI after 3 mo: 58.8%
Toshimori et al
[36], 2020
1
POEF for refractory
GERD with erosive
esophagitis after POEM
Endoscopy
Technical success without notable AE with maintaining the wrap at a 10mo follow-up endoscopy. Improved symptoms. No erosive esophagitis
Maydeo et al[37],
2023
30
EFTP
GERDQ; endoscopy.
24 pHmetry
Maintaining flap at 3 mo: 89.6%. AE: 13.8% “mild symptoms”. Symptoms
resolution and PPI stoppage after 6 mo: 72.4%. Improvement (> 50% from
baseline) in AET: 96.6%. GERDQ improvement by > 50% at 6 mo: 55.2%
Bapaye et al[32],
2021
25
POEM + F
GERDQ; endoscopy;
24 pHmetry
Technical success: 92%. Maintaining wrap at 12 mo: 82.6%. AE: 12%.
Abnormal AET at 2 mo: 11.1%. Erosive esophagitis at 2 mo: 18.2%
Ayoub et al[38],
2024
4
TIF + PPI
GERD-HRQL
75% of patients achieved either dose reduction or discontinuation of PPI.
Pre-TIF GERD-HRQL: 20 ± 18.5. Post-TIF GERD-HRQL: 3.75 ± 6.2
Hoerter et al[39],
2022
1
TIF
Endoscopy
Technical success without notable AE. Absence of esophagitis at a 9-mo
follow-up endoscopy
Kumta et al[40],
2015
1
TIF
Not assessed
Technical success without notable AE
DeWitt et al[41],
2024
17
TIF, cTIF
GERD-HRQL;
endoscopy; 24
pHmetry
At 9 mo follow-up: Stopped PPI: 80%. Pre-TIF esophagitis: 88%. Post-TIF
esophagitis: 50%. Pre-TIF total time reflux episode: 90.5 ± 46.9. Post-TIF
total time reflux episode: 49.3 ± 32.3
Tyberg et al[25],
2018
5
PPI + TIF
Endoscopy
Technical success: 100%. Complete resolution of symptoms: 100%
Shiwaku et al[15],
2022
1886
PPI
Endoscopy
Complete resolution of symptoms: 100% at 5-yr follow up
Nabi et al[42],
2020
167
PPI
Endoscopy
Complete resolution of esophagitis: 81.4%
Brewer Gutierrez
et al[43], 2020
67
PPI
Endoscopy; pHmetry At 48 mo follow-up erosive esophagitis: 16%. 47.5 % had AET despite being
on PPI
AE: Adverse event; AET: Acid exposure time; cTIF: Combined laparoscopic hernia repair and transoral incisionless fundoplication; EFTP: Endoscopic fullthickness plication GER: Gastroesophageal reflux; GERD: Gastroesophageal reflux disease; GERD-HRQL: Gastroesophageal reflux disease Health-Related
Quality of Life; GERDQ: Gastroesophageal reflux disease questionnaire; POEF: Peroral endoscopic fundoplication; POEM: Peroral endoscopic myotomy;
PPI: Proton pump inhibitor; RSI: Reflux symptom index; TIF: Transoral incisionless fundoplication.
which resolved spontaneously. Only 2 patients (11%) in this group developed GER after POEM[32]. In the United States,
Shrigiriwar et al[33] conducted the first United States study with 6 patients and achieved a technical success rate of 100%.
However, they did encounter some technical difficulties that need to be addressed in future research. These included the
off-label use of endoscopic accessories in POEM + F and the need for surgical anatomy awareness before performing such
a procedure.
In the Nabi et al[34] review article titled “Prediction, prevention, and management of gastroesophageal reflux after peroral endoscopic myotomy: An update” and published in the World Journal of Gastroenterology, the authors provided a wellorganized, comprehensive review of post-POEM GER in terms of risk factors, diagnosis, prevention, and management.
They provided an algorithm for the evaluation and management of post-POEM GER. Also, they summarized the
conclusions of the published papers with a simple and clear figure of the current understanding of post-POEM GER.
CONCLUSION
In our opinion, the diagnosis of GER after POEM should be determined using both objective and subjective approaches.
Questionnaires and other subjective approaches for diagnosing GER can be used in conjunction with objective procedures
WJG
https://www.wjgnet.com
2950
June 21, 2024
Volume 30
Issue 23
Tawheed A et al. Management of post-POEM GER
or to evaluate the quality of life of individuals suspected of having post-POEM GER. It has been reported that nearly 60%
of patients undergoing POEM may experience AET. Therefore, performing pHmetry, especially in symptomatic patients,
can prove to be helpful in assessing the need for an endoscopic anti-reflux procedure. However, delaying this testing for
at least 1 mo after the POEM procedure is important to avoid inaccurate results due to mucosal edema and damage.
Existing data on myotomy techniques indicate certain techniques that decrease the risk of developing GER. However,
these data were inconclusive. Therefore, when performing the POEM procedure, the choice of myotomy technique
should not be influenced by concerns about the development of post-POEM GER. Instead, the decision should be based
on the specific circumstances of the procedure, such as the difficulty level, the complexity of using the double-scope
technique, and the experience and preference of the endoscopist. However, a trial should be conducted to minimize the
length of the myotomy and lower the risk of prolonged post-POEM erosive esophagitis. The first line of management for
patients at risk of developing GER should always be PPIs, which are effective in treating esophagitis in most patients.
POEM + F is promising yet in the early stages of development. However, this procedure needs the endoscopist to have a
surgical background or be an expert in POEM and third-space endoscopic procedures, with a proficient surgical team
available as a backup. Long-term studies are necessary to validate the substantial risk associated with the procedure and
the long-term efficacy. In addition, accessories manufacturing companies should collaborate with endoscopists to design
necessary accessories to prevent off-label use of items such as endoloop, which may lead to various risks such as tool
change delays and losing position during the procedure.
FOOTNOTES
Author contributions: El-Kassas M designed the overall concept and outline of the manuscript; Tawheed A and Yalniz M wrote the
manuscript; Bahcecioglu IH provided critical technical points to the manuscript; All authors contributed to this article and approved the
final version of the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers.
It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to
distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the
original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Country of origin: Egypt
ORCID number: Ahmed Tawheed 0000-0002-9382-8733; Ibrahim Halil Bahcecioglu 0000-0001-9705-8281; Mehmet Yalniz 0000-0001-7776-4154;
Mohamed El-Kassas 0000-0002-3396-6894.
S-Editor: Wang JJ
L-Editor: Filipodia
P-Editor: Zhao YQ
REFERENCES
1
2
3
4
5
6
7
8
Rassoul Abu-Nuwar M, Eriksson SE, Sarici IS, Zheng P, Hoppo T, Jobe BA, Ayazi S. GERD after Peroral Endoscopic Myotomy:
Assessment of Incidence and Predisposing Factors. J Am Coll Surg 2023; 236: 58-70 [PMID: 36519909 DOI:
10.1097/XCS.0000000000000448]
Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J
Gastroenterol 2020; 115: 1393-1411 [PMID: 32773454 DOI: 10.14309/ajg.0000000000000731]
Minami H, Inoue H, Haji A, Isomoto H, Urabe S, Hashiguchi K, Matsushima K, Akazawa Y, Yamaguchi N, Ohnita K, Takeshima F, Nakao
K. Per-oral endoscopic myotomy: emerging indications and evolving techniques. Dig Endosc 2015; 27: 175-181 [PMID: 25040806 DOI:
10.1111/den.12328]
Chavan R, Nabi Z, Reddy N. Adverse events associated with third space endoscopy: Diagnosis and management. Int J Gastrointest Int 2020; 9
[DOI: 10.18528/ijgii200010]
Repici A, Fuccio L, Maselli R, Mazza F, Correale L, Mandolesi D, Bellisario C, Sethi A, Khashab MA, Rösch T, Hassan C. GERD after peroral endoscopic myotomy as compared with Heller's myotomy with fundoplication: a systematic review with meta-analysis. Gastrointest
Endosc 2018; 87: 934-943.e18 [PMID: 29102729 DOI: 10.1016/j.gie.2017.10.022]
Gyawali CP, Kahrilas PJ, Savarino E, Zerbib F, Mion F, Smout AJPM, Vaezi M, Sifrim D, Fox MR, Vela MF, Tutuian R, Tack J, Bredenoord
AJ, Pandolfino J, Roman S. Modern diagnosis of GERD: the Lyon Consensus. Gut 2018; 67: 1351-1362 [PMID: 29437910 DOI:
10.1136/gutjnl-2017-314722]
Kumbhari V, Familiari P, Bjerregaard NC, Pioche M, Jones E, Ko WJ, Hayee B, Cali A, Ngamruengphong S, Mion F, Hernaez R, Roman S,
Tieu AH, El Zein M, Ajayi T, Haji A, Cho JY, Hazey J, Perry KA, Ponchon T, Kunda R, Costamagna G, Khashab MA. Gastroesophageal
reflux after peroral endoscopic myotomy: a multicenter case-control study. Endoscopy 2017; 49: 634-642 [PMID: 28472834 DOI:
10.1055/s-0043-105485]
Werner YB, Hakanson B, Martinek J, Repici A, von Rahden BHA, Bredenoord AJ, Bisschops R, Messmann H, Vollberg MC, Noder T,
Kersten JF, Mann O, Izbicki J, Pazdro A, Fumagalli U, Rosati R, Germer CT, Schijven MP, Emmermann A, von Renteln D, Fockens P,
WJG
https://www.wjgnet.com
2951
June 21, 2024
Volume 30
Issue 23
Tawheed A et al. Management of post-POEM GER
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
Boeckxstaens G, Rösch T. Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. N Engl J Med 2019; 381: 2219-2229
[PMID: 31800987 DOI: 10.1056/NEJMoa1905380]
Karyampudi A, Nabi Z, Ramchandani M, Darisetty S, Goud R, Chavan R, Kalapala R, Rao GV, Reddy DN. Gastroesophageal reflux after
per-oral endoscopic myotomy is frequently asymptomatic, but leads to more severe esophagitis: A case-control study. United European
Gastroenterol J 2021; 9: 63-71 [PMID: 32723068 DOI: 10.1177/2050640620947645]
Maydeo A, Patil GK. Gastroesophageal reflux disease after peroral endoscopic myotomy: Facts and fictions. Int J Gastrointest Int 2020; 9: 6266 [DOI: 10.18528/ijgii200009]
Crookes PF, Corkill S, DeMeester TR. Gastroesophageal reflux in achalasia. When is reflux really reflux? Dig Dis Sci 1997; 42: 1354-1361
[PMID: 9246028 DOI: 10.1023/A:1018873501205]
Mota RCL, de Moura EGH, de Moura DTH, Bernardo WM, de Moura ETH, Brunaldi VO, Sakai P, Thompson CC. Risk factors for
gastroesophageal reflux after POEM for achalasia: a systematic review and meta-analysis. Surg Endosc 2021; 35: 383-397 [PMID: 32206921
DOI: 10.1007/s00464-020-07412-y]
Wang XH, Tan YY, Zhu HY, Li CJ, Liu DL. Full-thickness myotomy is associated with higher rate of postoperative gastroesophageal reflux
disease. World J Gastroenterol 2016; 22: 9419-9426 [PMID: 27895430 DOI: 10.3748/wjg.v22.i42.9419]
Li QL, Chen WF, Zhou PH, Yao LQ, Xu MD, Hu JW, Cai MY, Zhang YQ, Qin WZ, Ren Z. Peroral endoscopic myotomy for the treatment of
achalasia: a clinical comparative study of endoscopic full-thickness and circular muscle myotomy. J Am Coll Surg 2013; 217: 442-451 [PMID:
23891074 DOI: 10.1016/j.jamcollsurg.2013.04.033]
Shiwaku H, Sato H, Shimamura Y, Abe H, Shiota J, Sato C, Ominami M, Sakae H, Hata Y, Fukuda H, Ogawa R, Nakamura J, Tatsuta T,
Ikebuchi Y, Yokomichi H, Hasegawa S, Inoue H. Risk factors and long-term course of gastroesophageal reflux disease after peroral endoscopic
myotomy: A large-scale multicenter cohort study in Japan. Endoscopy 2022; 54: 839-847 [PMID: 35172368 DOI: 10.1055/a-1753-9801]
Wright AS, Williams CW, Pellegrini CA, Oelschlager BK. Long-term outcomes confirm the superior efficacy of extended Heller myotomy
with Toupet fundoplication for achalasia. Surg Endosc 2007; 21: 713-718 [PMID: 17332964 DOI: 10.1007/s00464-006-9165-9]
Nabi Z, Talukdar R, Mandavdhare H, Reddy DN. Short versus long esophageal myotomy during peroral endoscopic myotomy: A systematic
review and meta-analysis of comparative trials. Saudi J Gastroenterol 2022; 28: 261-267 [PMID: 34806659 DOI: 10.4103/sjg.sjg_438_21]
Hong HJ, Song GW, Ko WJ, Kim WH, Hahm KB, Hong SP, Cho JY. Double-Scope Peroral Endoscopic Myotomy (POEM) for Esophageal
Achalasia: The First Trial of a New Double-Scope POEM. Clin Endosc 2016; 49: 383-386 [PMID: 26975862 DOI: 10.5946/ce.2015.108]
Grimes KL, Bechara R, Shimamura Y, Ikeda H, Inoue H. Gastric myotomy length affects severity but not rate of post-procedure reflux: 3-year
follow-up of a prospective randomized controlled trial of double-scope per-oral endoscopic myotomy (POEM) for esophageal achalasia. Surg
Endosc 2020; 34: 2963-2968 [PMID: 31463720 DOI: 10.1007/s00464-019-07079-0]
Shiwaku H, Inoue H, Shiwaku A, Okada H, Hasegawa S. Safety and effectiveness of sling fiber preservation POEM to reduce severe postprocedural erosive esophagitis. Surg Endosc 2022; 36: 4255-4264 [PMID: 34716481 DOI: 10.1007/s00464-021-08763-w]
Tanaka S, Kawara F, Toyonaga T, Inoue H, Bechara R, Hoshi N, Abe H, Ohara Y, Ishida T, Morita Y, Umegaki E. Two penetrating vessels as
a novel indicator of the appropriate distal end of peroral endoscopic myotomy. Dig Endosc 2018; 30: 206-211 [PMID: 28846807 DOI:
10.1111/den.12957]
Inoue H, Shiwaku H, Kobayashi Y, Chiu PWY, Hawes RH, Neuhaus H, Costamagna G, Stavropoulos SN, Fukami N, Seewald S, Onimaru M,
Minami H, Tanaka S, Shimamura Y, Santi EG, Grimes K, Tajiri H. Statement for gastroesophageal reflux disease after peroral endoscopic
myotomy from an international multicenter experience. Esophagus 2020; 17: 3-10 [PMID: 31559513 DOI: 10.1007/s10388-019-00689-6]
Familiari P, Greco S, Gigante G, Calì A, Boškoski I, Onder G, Perri V, Costamagna G. Gastroesophageal reflux disease after peroral
endoscopic myotomy: Analysis of clinical, procedural and functional factors, associated with gastroesophageal reflux disease and esophagitis.
Dig Endosc 2016; 28: 33-41 [PMID: 26173511 DOI: 10.1111/den.12511]
Minami H, Isomoto H, Yamaguchi N, Matsushima K, Akazawa Y, Ohnita K, Takeshima F, Inoue H, Nakao K. Peroral endoscopic myotomy
for esophageal achalasia: clinical impact of 28 cases. Dig Endosc 2014; 26: 43-51 [PMID: 23581563 DOI: 10.1111/den.12086]
Tyberg A, Choi A, Gaidhane M, Kahaleh M. Transoral incisional fundoplication for reflux after peroral endoscopic myotomy: a crucial
addition to our arsenal. Endosc Int Open 2018; 6: E549-E552 [PMID: 29756011 DOI: 10.1055/a-0584-6802]
Inoue H, Ueno A, Shimamura Y, Manolakis A, Sharma A, Kono S, Nishimoto M, Sumi K, Ikeda H, Goda K, Onimaru M, Yamaguchi N, Itoh
H. Peroral endoscopic myotomy and fundoplication: a novel NOTES procedure. Endoscopy 2019; 51: 161-164 [PMID: 30654395 DOI:
10.1055/a-0820-2731]
Ihde GM. The evolution of TIF: transoral incisionless fundoplication. Therap Adv Gastroenterol 2020; 13: 1756284820924206 [PMID:
32499834 DOI: 10.1177/1756284820924206]
Cadière GB, Rajan A, Rqibate M, Germay O, Dapri G, Himpens J, Gawlicka AK. Endoluminal fundoplication (ELF)--evolution of EsophyX,
a new surgical device for transoral surgery. Minim Invasive Ther Allied Technol 2006; 15: 348-355 [PMID: 17190659 DOI:
10.1080/13645700601040024]
Brewer Gutierrez OI, Benias PC, Khashab MA. 917 Same session per-oral endoscopic myotomy (POEM) followed by transoral incisionless
fundoplication (TIF) in Achalasia: Are we there yet? Gastroint Endosc 2019; 89: AB126 [DOI: 10.1016/j.gie.2019.04.151]
Brewer Gutierrez OI, Chang KJ, Benias PC, Sedarat A, Dbouk MH, Godoy Brewer G, Lee DP, Okolo Iii PI, Canto MI, Khashab MA. Is
transoral incisionless fundoplication (TIF) an answer to post-peroral endoscopic myotomy gastroesophageal reflux? A multicenter retrospective
study. Endoscopy 2022; 54: 305-309 [PMID: 34049409 DOI: 10.1055/a-1446-8953]
Wendling MR, Melvin WS, Perry KA. Impact of transoral incisionless fundoplication (TIF) on subjective and objective GERD indices: a
systematic review of the published literature. Surg Endosc 2013; 27: 3754-3761 [PMID: 23644835 DOI: 10.1007/s00464-013-2961-0]
Bapaye A, Dashatwar P, Dharamsi S, Pujari R, Gadhikar H. Single-session endoscopic fundoplication after peroral endoscopic myotomy
(POEM+F) for prevention of post gastroesophageal reflux - 1-year follow-up study. Endoscopy 2021; 53: 1114-1121 [PMID: 33291157 DOI:
10.1055/a-1332-5911]
Shrigiriwar A, Zhang LY, Ghandour B, Bejjani M, Mony S, Bapaye A, Khashab MA. Technical details and outcomes of peroral endoscopic
myotomy with fundoplication: the first U.S. experience (with video). Gastrointest Endosc 2023; 97: 585-593 [PMID: 36265528 DOI:
10.1016/j.gie.2022.10.027]
Nabi Z, Inavolu P, Duvvuru NR. Prediction, prevention and management of gastroesophageal reflux after per-oral endoscopic myotomy: An
update. World J Gastroenterol 2024; 30: 1096-1107 [PMID: 38577183 DOI: 10.3748/wjg.v30.i9.1096]
Patil G, Dalal A, Maydeo A. Early outcomes of peroral endoscopic myotomy with fundoplication for achalasia cardia - Is it here to stay? Dig
Endosc 2021; 33: 561-568 [PMID: 32691889 DOI: 10.1111/den.13796]
WJG
https://www.wjgnet.com
2952
June 21, 2024
Volume 30
Issue 23
Tawheed A et al. Management of post-POEM GER
36
37
38
39
40
41
42
43
Toshimori A, Inoue H, Shimamura Y, Abad MRA, Onimaru M. Peroral endoscopic fundoplication: a brand-new intervention for GERD.
VideoGIE 2020; 5: 244-246 [PMID: 32529158 DOI: 10.1016/j.vgie.2020.02.018]
Maydeo A, Patil G, Kamat N, Dalal A, Vadgaonkar A, Parekh S, Daftary R, Vora S. Endoscopic full-thickness plication for the treatment of
gastroesophageal reflux after peroral endoscopic myotomy: a randomized sham-controlled study. Endoscopy 2023; 55: 689-698 [PMID:
36944359 DOI: 10.1055/a-2040-4042]
Ayoub F, Keihanian T, Zabad N, Jawaid S, Patel K, Othman MO. The role of transoral incisionless fundoplication (TIF) in the management of
gastroesophageal reflux disease (GERD) following peroral endoscopic myotomy (POEM): A pilot, prospective, patient-driven study. Saudi J
Gastroenterol 2024 [PMID: 38465439 DOI: 10.4103/sjg.sjg_22_24]
Hoerter NA, Dixon RE, DiMaio CJ, Nagula S, Greenwald D, Kumta NA. Tandem peroral endoscopic myotomy (POEM) and transoral
incisionless fundoplication: a strategy to reduce reflux after POEM. Endoscopy 2022; 54: E368-E369 [PMID: 34374047 DOI:
10.1055/a-1540-6558]
Kumta NA, Kedia P, Sethi A, Kahaleh M. Transoral incisionless fundoplication for treatment of refractory GERD after peroral endoscopic
myotomy. Gastrointest Endosc 2015; 81: 224-225 [PMID: 25016405 DOI: 10.1016/j.gie.2014.05.321]
DeWitt JM, Al-Haddad M, Stainko S, Perkins A, Fatima H, Ceppa DP, Birdas TJ. Transoral incisionless fundoplication with or without hiatal
hernia repair for gastroesophageal reflux disease after peroral endoscopic myotomy. Endosc Int Open 2024; 12: E43-E49 [PMID: 38188922
DOI: 10.1055/a-2215-3415]
Nabi Z, Ramchandani M, Kotla R, Tandan M, Goud R, Darisetty S, Rao GV, Reddy DN. Gastroesophageal reflux disease after peroral
endoscopic myotomy is unpredictable, but responsive to proton pump inhibitor therapy: a large, single-center study. Endoscopy 2020; 52: 643651 [PMID: 32208499 DOI: 10.1055/a-1133-4354]
Brewer Gutierrez OI, Moran RA, Familiari P, Dbouk MH, Costamagna G, Ichkhanian Y, Seewald S, Bapaye A, Cho JY, Barret M,
Eleftheriadis N, Pioche M, Hayee BH, Tantau M, Ujiki M, Landi R, Invernizzi M, Yoo IK, Roman S, Haji A, Hedberg HM, Parsa N, Mion F,
Fayad L, Kumbhari V, Agarwalla A, Ngamruengphong S, Sanaei O, Ponchon T, Khashab MA. Long-term outcomes of per-oral endoscopic
myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study. Endosc Int Open 2020; 8: E650-E655 [PMID:
32355884 DOI: 10.1055/a-1120-8125]
WJG
https://www.wjgnet.com
2953
June 21, 2024
Volume 30
Issue 23
Published by Baishideng Publishing Group Inc
7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Telephone: +1-925-3991568
E-mail: office@baishideng.com
Help Desk: https://www.f6publishing.com/helpdesk
https://www.wjgnet.com
© 2024 Baishideng Publishing Group Inc. All rights reserved.