Long-term (3-year) composite gastroesophageal reflux outcomes of peroral endoscopic myotomy with or without concomitant endoscopic fundoplication in matched cohorts of achalasia

Amol Bapaye; Rohan Yewale; Jimil Shah; Ajay Bale R; Jaseem Ansari; Mangesh Borkar; Harsh Bapaye; Rajendra Pujari; Harshal Gadhikar

doi:10.1016/j.gie.2025.04.029

Long-term (3-year) composite gastroesophageal reflux outcomes of peroral endoscopic myotomy with or without concomitant endoscopic fundoplication in matched cohorts of achalasia

Gastrointest Endosc. 2025 Apr 25:S0016-5107(25)01622-0. doi: 10.1016/j.gie.2025.04.029. Online ahead of print.

Authors

Amol Bapaye¹, Rohan Yewale², Jimil Shah³, Ajay Bale R², Jaseem Ansari², Mangesh Borkar², Harsh Bapaye⁴, Rajendra Pujari², Harshal Gadhikar²

Affiliations

¹ Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India. Electronic address: amolbapaye@gmail.com.
² Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
³ Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
⁴ Department of Internal Medicine, Byramjee Jeejeebhoy Medical College, Pune, India.

PMID: 40288696
DOI: 10.1016/j.gie.2025.04.029

Abstract

Background and aims: Peroral endoscopic myotomy (POEM) is well established for the treatment of achalasia. Post-POEM gastroesophageal reflux (GER) has been identified as a concern. Concomitant endoscopic fundoplication (POEM + F) may reduce post-POEM GER. This study compares composite (objective and subjective) GER outcomes at 3 years' follow-up in a matched cohort of patients with achalasia undergoing POEM versus POEM + F.

Methods: This single-center, retrospective, matched cohort study compared POEM + F versus POEM. It used retrospective matching with criteria as follows: age, sex, body mass index, achalasia type, prior interventions, and American Society of Anesthesiologists status. Baseline characteristics, pre/postprocedure Eckardt scores (ESs), technical aspects, and AEs were recorded. Both groups were followed up annually for 3 years. Outcomes were compared at 3 years. The primary outcome was the incidence of objective GER (Lyon Consensus 2.0); and secondary outcomes were subjective (symptomatic) GER (GERD questionnaire, Reflux Symptom Index, GERD health-related quality of life), and clinical success (ES <3). P < .05 was considered significant.

Results: Thirty-four POEM + F patients were matched to 34 POEM patients (total consecutive POEM + F = 41; excluded = 7 [technical failure, = 2; unsuitable match, = 5]). AEs included mucosal injury (POEM vs POEM-F, 11.8% vs 8.8%; P = .69). One recurrence (POEM + F) at 9 months was excluded for long-term follow-up. At the 3-year follow-up, objective GER (esophageal acid exposure time >6% and/or Grade B or higher esophagitis) was observed in 2 (13.3%) of 15 patients (POEM + F) versus 7 (58.3%) of 12 (POEM) (P = .037). Wrap integrity was maintained in 76.5% of POEM + F cases at 3 years. Symptomatic GER (symptom scores) was low and comparable in both groups. Clinical success (ES <3) was sustained in all except 1 patient with recurrence (98.5%).

Conclusions: In a retrospective matched cohort, GER was significantly less frequent after POEM + F than only POEM, and wrap integrity was maintained in three-fourths of patients at the 3-year follow-up.