Peroral endoscopic myotomy and valve section for treatment of persistent and disabling dysphagia after laparoscopic fundoplication (with video)

Background and aims Laparoscopic fundoplication (LF), treating refractory gastro-esophageal reflux (GERD), may induce refractory dysphagia (5-10%). The management is complex, and POEM including valve incision is a new therapeutic option. Methods Retrospective study involving patients with post-fundoplication refractory dysphagia treated by POEM associated with complete wrap incision. Patients were evaluated with Eckardt and Dysphagia scores. The objectives were to evaluate the clinical and technical outcomes, complications, and GERD recurrence. Results Twenty-six patients, mean age 57.3 ± 15.6 years old, were included. Mean follow-up was 25.3 ± 17.6 month. The technical and clinical success rates were 96% and 84.6%, respectively. Among failures, one underwent Lewis-Santy, two required dilations, and one was lost in follow-up. Three late recurrences occurred, endoscopically managed. Five patients (19%) had GERD recurrence, mainly improved by PPIs. Conclusion FP-POEM is a serious therapeutic option for managing persistent dysphagia after LF, with low risk of GERD recurrence.