ArticleSurgical endoscopy2026
Reflux symptom burden and objective findings at long-term follow-up after peroral endoscopic myotomy.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPeroral endoscopic myotomy (POEM) effectively treats achalasia but confers a significant risk of postoperative gastroesophageal reflux. Studies demonstrate poor short-term correlation between reflux symptoms and objective findings, but long-term outcomes remain unclear. We evaluated long-term GERD Health-Related Quality of Life (GERD-HRQL) scores, Bravo pH results, and proton pump inhibitor (PPI) use after POEM.
methodsWe conducted a prospective survey study of adults who underwent POEM at our institution from 2011 to 2024 with > 1 year of follow-up. Standardized surveys included the validated GERD-HRQL questionnaire and questions regarding PPI use and post-POEM interventions. Chart review verified medication use, Bravo results, and endoscopic findings. The primary endpoint was reflux symptom control, defined as GERD-HRQL score < 10. Secondary endpoints included chronic PPI use (> 6 months), Bravo results, and the reflux-dysphagia relationship. Multivariable logistic regression identified predictors of reflux symptom control.
resultsSeventy-nine patients completed the questionnaire at a median follow-up of 68 months. The median GERD-HRQL score was 10 (IQR 4-17), with 42 patients (53.2%) reporting clinically significant reflux (GERD-HRQL ≥ 10). Most (58; 73.4%) had chronic PPI use, 55.2% of whom reported poor symptom control. Among patients with GERD-HRQL ≥ 10, 52.4% had Eckardt scores > 3, suggesting concurrent dysphagia. Thirty-one patients underwent post-POEM Bravo; results were negative in 13 (41.9%), positive in 13 (41.9%), and inconclusive in 5 (16.1%). Six of 10 Bravos performed for reflux symptoms were negative. Endoscopy (n = 56) demonstrated esophagitis in 16 patients (28.6%). Older age (OR 1.04; 95% CI 1.01-1.08) and preoperative weight loss ≥ 5 kg (OR 6.72; 95% CI 1.57-28.74) predicted reflux control on multivariable analysis.
conclusionsAt long-term follow-up, over half of patients reported clinically significant reflux, and most required chronic PPI therapy. Reflux symptoms correlated inconsistently with objective findings, mirroring short-term data and highlighting the need for ongoing surveillance and targeted reflux mitigation after POEM.
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