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Anterior versus posterior peroral endoscopic myotomy: 2-years post-procedure follow-up from a randomized controlled trial.

BACKGROUND AND AIMS
Peroal endoscopic myotomy (POEM) is considered a primary treatment modality for achalasia. It can be performed using either the anterior or posterior approach. A previous randomized clinical trial showed that the posterior approach was non-inferior to the anterior approach at 1-year post-POEM in terms of clinical success, rate of adverse event and risk of gastroesophageal reflux disease (GERD). The aim of this post-RCT study is to compare the outcomes at ≥ 2-years post-POEM.


METHODS
Patients who previously completed their 1-year follow-up were contacted and their Eckardt (ES), Dysphagia, and Gastroesophageal Reflux Disease Questionnaire (GERDQ) scores and frequency of proton pump inhibitor (PPI) use were recorded. Clinical success was defined as ES<3.


RESULTS
A total of 150 patients were initially randomized and 138 completed their 1-year follow-up. Out of the 138, 111 (anterior group 54, posterior group 57) completed their ≥ 2-years follow-up with an overall clinical success decrease from 89% to 82%. At ≥ 2-years post-POEM, clinical success was achieved in 46/54 (85%) and 45/57 (79%) in the anterior and posterior groups, respectively (p=0.43). A similar decrease in clinical success was noted in both groups at ≥ 2-years (anterior: 90% to 85%; posterior 89% to 79%; p=0.5). GERDQ score was 6 (IQR: 6-8) (p = 0.08) in both treatment groups.


CONCLUSIONS
The anterior and posterior POEM techniques remained equally effective at 2 years and a similar decrease in efficacy was noted over time. GERD outcomes were also similar between both groups during medium-term follow-up.