Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2024; 30(22): 2834-2838
Published online Jun 14, 2024. doi: 10.3748/wjg.v30.i22.2834
Gastroesophageal reflux following per-oral endoscopic myotomy: Can we improve outcomes?
Inian Samarasam, Raj Kumar Joel, Anna B Pulimood
Inian Samarasam, Department of Surgery, Upper Gastrointestinal Surgery Unit, Christian Medical College & Hospital, Vellore 632004, Tamilnadu, India
Raj Kumar Joel, Department of Cardiothoracic Surgery, Christian Medical College & Hospital, Vellore 632004, Tamilnadu, India
Anna B Pulimood, Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
Author contributions: Samarasam I contributed to conception and design and was involved in the analysis, drafting, discussion, review of literature and provision of final approval for publication; Joel RK and Pulimood AB contributed to the design of the research study, acquisition & interpretation of data, illustrations, critical revisions, editing of the manuscript and provision of final approval for publication.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Inian Samarasam, FRCS, MS, Professor, Department of Surgery, Upper Gastrointestinal Surgery Unit, Christian Medical College & Hospital, Ida Scudder Road, Vellore 632004, Tamilnadu, India. inians@cmcvellore.ac.in
Received: March 10, 2024
Revised: April 30, 2024
Accepted: May 20, 2024
Published online: June 14, 2024
Processing time: 87 Days and 21.7 Hours

This editorial is an analysis the review article by Nabi et al recently published in this journal. Achalasia Cardia is a disease whose pathophysiology is still unclear. It is known that there is inflammation of unknown aetiology leading to loss of ganglion cells in the muscularis propria. The end result is lower oesophageal sphincter spasm, loss of receptive relaxation, decreased oesophageal peristalsis, all leading on to varying degrees of dysphagia. The treatment of this condition is palliative in nature, performed by myotomy of the lower oesophagus either surgically or endoscopically. Gastroesophageal reflux disease (GERD) has been associated with the myotomy performed, particularly with the Peroral Endoscopic Myotomy (POEM) procedure. Nabi et al have provided an excellent overview of the latest developments in predicting, preventing, evaluating, and managing GERD subsequent to POEM. Based on this theme, this review article explores the concept of using histology of the oesophageal muscle layer, to grade the disease and thereby help tailoring the length/type of myotomy performed during the POEM procedure. In the future, will a histology based algorithm available preoperatively, help modify the POEM procedure, thereby decreasing the incidence of GERD associated with POEM?

Keywords: Achalasia cardia, Peroral endoscopic myotomy, Laparoscopic Heller’s myotomy, Histopathology, Histologic grading

Core Tip: Gastro Esophageal Reflux disease (GERD) is a side effect of the Peroral Endoscopic Myotomy (POEM) procedure done for Achalasia Cardia (AC). There is still lack of clear understanding of the histologic changes associated AC and its correlation with the natural history of the disease. The question put forward in this editorial is whether a histology based algorithm to modify the POEM procedure, will help decrease the incidence of GERD associated with POEM. This article is written to provide a deeper insight into the problem and provide thought for further research on this important, yet unexplored area in the management of AC.