Tawheed A, Bahcecioglu IH, Yalniz M, El-Kassas M. Gastroesophageal reflux after per-oral endoscopic myotomy: Management literature. World J Gastroenterol 2024; 30(23): 2947-2953 [PMID: 38946871 DOI: 10.3748/wjg.v30.i23.2947]
Corresponding Author of This Article
Mohamed El-Kassas, MD, Full Professor, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Ain Helwan, Cairo 11795, Egypt. m_elkassas@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jun 21, 2024; 30(23): 2947-2953 Published online Jun 21, 2024. doi: 10.3748/wjg.v30.i23.2947
Gastroesophageal reflux after per-oral endoscopic myotomy: Management literature
Ahmed Tawheed, Ibrahim Halil Bahcecioglu, Mehmet Yalniz, Mohamed El-Kassas
Ahmed Tawheed, Mohamed El-Kassas, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
Ibrahim Halil Bahcecioglu, Mehmet Yalniz, Department of Gastroenterology, Faculty of Medicine, Firat University, Elazig 23119, Türkiye
Mohamed El-Kassas, Liver Disease Research Center, College of Medicine, King Saud University, Riyadh 7805, Saudi Arabia
Author contributions: El-Kassas M designed the overall concept and outline of the manuscript; Tawheed A and Yalniz M wrote the manuscript; Bahcecioglu IH provided critical technical points to the manuscript; All authors contributed to this article and approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
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: Mohamed El-Kassas, MD, Full Professor, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Ain Helwan, Cairo 11795, Egypt. m_elkassas@yahoo.com
Received: March 13, 2024 Revised: May 6, 2024 Accepted: May 20, 2024 Published online: June 21, 2024 Processing time: 99 Days and 14.9 Hours
Abstract
In this editorial, we respond to a review article by Nabi et al, in which the authors discussed gastroesophageal reflux (GER) following peroral endoscopic myotomy (POEM). POEM is presently the primary therapeutic option for achalasia, which is both safe and effective. A few adverse effects were documented after POEM, including GER. The diagnostic criteria were not clear enough because approximately 60% of patients have a long acid exposure time, while only 10% experience reflux symptoms. Multiple predictors of high disease incidence have been identified, including old age, female sex, obesity, and a baseline lower esophageal sphincter pressure of less than 45 mmHg. Some technical steps during the procedure, such as a lengthy or full-thickness myotomy, may further enhance the risk. Proton pump inhibitors are currently the first line of treatment. Emerging voices are increasingly advocating for the routine combining of POEM with an endoscopic fundoplication method, such as peroral endoscopic fundoplication or transoral incisionless fundoplication. However, more research is necessary to determine the safety and effectiveness of these procedures in the long term for patients who have undergone them.
Core Tip: In this editorial, we discuss the current objective measures for diagnosing gastroesophageal reflux (GER) after peroral endoscopic myotomy (POEM). We also review the factors that contribute to this adverse event, including patient and technique-related characteristics. Furthermore, we provide a list of all published studies on the various treatment options available for post-POEM GER, such as proton pump inhibitors, peroral endoscopic fundoplication, and transoral incisionless fundoplication.
