Introduction:

The efficacy of peroral endoscopic myotomy (POEM) for the relief of dysphagia is greater than 90%, being comparable with Heller’s myotomy, it is even a therapeutic alternative in patients with recurrence or persistence of symptoms after Heller’s myotomy. The control of long-term dysphagia, progression of esophageal dilation and reflux after the procedure is still being evaluated. The treatment of achalasia by peroral endoscopic myotomy is associated with a higher incidence of gastroesophageal reflux disease (GERD), compared to alternative therapies such as Heller myotomy or pneumatic dilatation.

Objective:

To determine the abnormal acid exposure in patients undergoing POEM due to diagnosis of achalasia and to evaluate its association with the degrees of esophagitis according to Los Angeles classification. Secondary objectives: to determine the association of abnormal acid exposure postPOEM with the type of achalasia and the length of the myotomy.

Materials and methods:

All patients undergoing POEM for diagnosis of achalasia in the period from January of the year 2015 to December of 2018 were included. We excluded patients with a previous Heller’s myotomy or hiatus surgery.

Results:

A total of 45 patients were included. There were no differences between abnormal acid exposure and age (p 0.96), sex (p 0.29), type of achalasia (p 0.48), length of myotomy (p 0.51) or degree of esophagitis according to Los Angeles scale (p 0.22). There were no differences between the patients who presented some endoscopic degree of esophagitis according to Los Angeles classification and the type of achalasia (p 0.80), the length of the myotomy (p 0.99), the percentage of acid exposure in 24 hours (p 0.28). There is a tendency (p 0.08) to the association between the presence of esophagitis and the abnormal acid exposure.

Conclusions:

The POEM technique has gained worldwide acceptance due to the efficacy to treat dysphagia; comparable in some cases to Heller’s myotomy. In this study developed in our population and in others with more representative samples, predictive factors for the development of gastroesophageal reflux after POEM in patients with achalasia have not been found. This leads us to look for endoscopic alternatives in the treatment of GERD to solidify the efficacy of POEM for the treatment of achalasia.

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