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\u003c3. 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.