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Endoscopic or Surgical Myotomy in Patients With Idiopathic Achalasia

Thursday, December 19, 2019

Submitted by

Aristotle Protopapas

Source

Source Name: The New England Journal of Medicine

Source URL: https://www.nejm.org/doi/full/10.1056/NEJMoa1905380

Author(s)

Yuki B. Werner, Bengt Hakanson, Jan Martinek, Alessandro Repici, Burkhard H.A. von Rahden, Albert J. Bredenoord, Raf Bisschops, Helmut Messmann, Marius C. Vollberg, Tania Noder, Jan F. Kersten, Oliver Mann, Jakob Izbicki, Alexander Pazdro, Uberto Fumagalli, Riccardo Rosati, Christoph-Thomas Germer, Marlies P. Schijven, Alice Emmermann, Daniel von Renteln, Paul Fockens, Guy Boeckxstaens, Thomas Rösch

A medium-size RCT on the growing research question of efficacy of peroral myotomy for achalasia, with a 17% failure to improve symptoms in the peroral endoscopic myotomy (POEM) arm, is discussed in this article. It recognizes a quite sobering incidence of endoscopically-evidenced reflux esophagitis in both arms, bafflingly improving between 3 and 24 months in the POEM group and increasing in the controls (Dor), while the incidence in the POEM arm was double!