Gastroesophageal reflux after per-oral endoscopic myotomy: Management literature

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 10-mo 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 full-thickness 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.