Gastroesophageal reflux after per-oral endoscopic myotomy: what should we know?

Gastroesophageal reflux after per-oral endoscopic myotomy

Abstract

Achalasia is a primary esophageal motility disorder, characterized by the distal motility disorder with high-level pressure in the lower esophageal sphincter (LES). Nowadays, POEM, as a novel endoscopic technology, has been accepted by the majority of patients with achalasia. The efficacy of POEM is evident in most studies; however, most researchers have found that the occurrence of gastroesophageal reflux (GER) after POEM is also much higher than other two therapies. The reasons for post-POEM GER mainly includes destroying the structure of LES, abnormal peristalsis of esophageal body and without a fundoplication as Heller surgery. In addition, the sensitivity and specificity to diagnose GER through symptom are lower, we need a comprehensive analysis of symptom, endoscopy and 24-hour pH monitoring. The endoscopy has its unique advantages in biopsy for early detection of esophageal cancer. 24-hour pH testing can distinguish between reflux and food fermentation. For patients with refractory GER, genotype cytochrome P450 2C19 variability may be the cause of them. Therefore, for those patients, they can use PPIs with less affected by CYP2C19 and think about the option of therapeutic endoscopy.