Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2024; 30(21): 2740-2743
Published online Jun 7, 2024. doi: 10.3748/wjg.v30.i21.2740
Navigating reflux disease after achalasia treatments: Balancing risks and benefits
Ewen A Griffiths, Enoch Wong
Ewen A Griffiths, Enoch Wong, Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, West Midlands, United Kingdom
Ewen A Griffiths, Department of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, West Midlands, United Kingdom
Author contributions: Wong E and Griffiths EA both were involved in the planning, writing and editing of this editorial.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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/
Corresponding author: Ewen A Griffiths, FRCS (Gen Surg), MD, Professor, Surgeon, Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2GW, West Midlands, United Kingdom. ewen.griffiths@uhb.nhs.uk
Received: February 24, 2024
Revised: April 29, 2024
Accepted: May 16, 2024
Published online: June 7, 2024
Processing time: 99 Days and 15.7 Hours
Abstract

The peroral endoscopic myotomy (POEM) procedure has revolutionized the management of achalasia in many centres around the world as it offers patients a minimally invasive endoscopic solution to their dysphagia caused by achalasia. Alongside its success in alleviating dysphagia, concerns regarding postoperative gastroesophageal reflux disease have emerged as a pertinent issue which are not fully resolved. In this study, Nabi et al have comprehensively reviewed the topic of the prediction, prevention and management of gastroesophageal reflux after POEM. POEM is a purely endoscopic procedure which is usually performed without any anti-reflux procedure. Certain patients may be better served by a laparoscopic Heller’s myotomy and fundoplication and it is important that gastroenterologists and surgeons provide comprehensive risks and benefits of each achalasia treatment option so that patients can decide what treatment is best for them. This article by Nabi et al provides a comprehensive review of the current status of this issue to allow these discussions to occur.

Keywords: Achalasia; Gastro-esophageal reflux disease; Laparoscopic heller’s myotomy; Peroral endoscopic myotomy; Fundoplication

Core Tip: Risk factors for post peroral endoscopic myotomy (POEM) gastroesophageal reflux disease highlighted in the review are a higher body mass index > 35 kg/m2, the presence of hiatal hernia, a low integrated relaxation pressure post-POEM, pre-POEM lower esophageal sphincter (LES) pressures below 45 mmHg, low post-POEM LES pressure, and female gender. The achalasia community should perhaps consider whether these patients might be better suited to a laparoscopic Heller’s cardiomyotomy and partial fundoplication rather than a POEM.