Repeat peroral endoscopic myotomy with simultaneous submucosal and muscle dissection as a salvage option for recurrent achalasia

Table 1 Demography and clinical profile of patients with recurrent achalasia after initial peroral endoscopic myotomy

	Total (n = 16)	Re-POEM (n = 9)	Re-POEM-SSMD (n = 7)	P value
Age, mean ± SD, yr	43.4 ± 16.3	43.0 ± 15.4	43.86 ± 18.7	0.916
Male, n (%)	9 (56.3)	4 (44.4)	5 (71.4)	0.008
Duration of dysphagia, median (range), mo	86.5 (16-420)	92 (16-147)	24 (16-420)	0.751
Time symptoms recurred after initial POEM, median (range), mo	15.5 (0-92)	12 (0-92)	7.5 (0-50)	0.414
Interval between initial POEM and Re-POEM, median (range), mo	45.5 (4-95)	64 (14-95)	9 (4-60)	0.013
Achalasia endoscopy type, n (%)
Ling I	2 (12.5)	2 (22.2)	0 (0)
Ling IIa	5 (31.3)	3 (33.3)	2 (28.6)
Ling IIb	1 (6.3)	0 (0)	1 (14.3)
Ling IIc	5 (31.3)	3 (33.3)	2 (28.6)
Ling IIIr	3 (18.8)	1 (11.1)	2 (28.6)

The values are expressed as mean ± SD or medians (range) for quantitative data, and n (%) for categorical data. SD: Standard deviation; POEM: Peroral endoscopic myotomy; Re-POEM: Repeat peroral endoscopic myotomy; Re-POEM-SSMD: Repeat peroral endoscopic myotomy with simultaneous submucosal and muscle dissection.

Table 2 Operation information and treatment outcomes of patients with recurrent achalasia after initial peroral endoscopic myotomy

	Re-POEM (n = 9)	Re-POEM-SSMD (n = 7)	P value
Operation parameters
Operative time, mean ± SD, min	39.22 ± 15.19	47.86 ± 9.71	0.414
Submucosal tunnel length, median (range), cm	9 (7-13)	5 (4-12)	0.012
Myotomy length, median (range), cm	6 (4.5-11)	6 (4-11)	1.000
Postoperative hospital stay, mean ± SD, d	6.0 ± 1.7	7.1 ± 1.3	0.454
Adverse events, n
Mucosal injury	0	1
Subcutaneous emphysema	0	0
Pneumothorax	0	0
Pneumoperitoneum	2	0
Tunnel infection	0	0
Clinical success during follow-up, n (%)	8 (88.9)	6 (85.7)	0.849
Eckardt score, median (range)
Pre-POEM	6 (2-8)	5 (2-8)	0.892
Preretreatment	4 (3–8)	5 (2-8)	0.425
Postretreatment	1 (0-5)	2 (0-4)	0.416
Lower esophageal sphincter pressure, mean ± SD, mmHg
Preretreatment	23.78 ± 9.04	26.80 ± 7.48	0.489
Postretreatment	11.45 ± 5.37	11.05 ± 4.38	0.872
Reflux complications
Symptomatic reflux, n (%)	6 (66.7)	0 (0)	0.001
R, n (%)	6 (66.7)	3 (42.9)	0.100

SD: Standard deviation; POEM: Peroral endoscopic myotomy; Re-POEM: Repeat peroral endoscopic myotomy; Re-POEM-SSMD: Repeat peroral endoscopic myotomy with simultaneous submucosal and muscle dissection.