Discussion
achalasia, failure of tunnel closure
ADVERSE EVENTS, ACHALASIA
The present work demonstrates that the efficacy, feasibility and safety of POEM are comparable between treatment-naïve and non-naïve patients with achalasia. Firstly, the clinical success rate at 6 months was at 93% in POEM1 patients and 84% in POEM2 patients without a significant difference between the two groups. Secondly, oesophageal myotomy was successfully performed in all patients; however, two POEM2 patients experienced a failure of tunnel closure by clips, which was successfully treated by oesophageal stenting. Thirdly, the occurrence of procedural, post-procedural and late adverse events and the length of hospital stay was not significantly different between the groups. Together, these results suggest that POEM could be proposed as a second-line treatment for patients with persistent symptoms after surgical or endoscopic treatment of achalasia.Other studies have compared the feasibility and the outcomes of POEM between treatment-naïve and non-naïve patients with achalasia [Overall, the rates of severe adverse events and clinical success at 6 months were 2% and 89%, which are, respectively, higher and lower than the rates reported by large series [The median length of hospital stay was similar in the 2 groups. Although it may seem long compared with previous studies [In conclusion, POEM appears to be an effective, feasible and safe approach for patients who have undergone either endoscopic or surgical treatment for achalasia and can thus be offered as a second-therapeutic line. Prospective long-term follow-up to confirm these data is required.