Evaluation and Treatment of Post-POEM Gastroesophageal Reflux Disease

Gastroesophageal reflux is a frequently described outcome of lower esophageal sphincter (LES) per-oral endoscopic myotomy (POEM). Diagnosis of clinically relevant post-POEM GERD requires careful assessment of pattern of esophageal acidification on pH testing, identification of anatomic disruptions such as hiatal hernia or distal esophageal angulation, and severity of mucosal disease. While antisecretory medications are the mainstay of treatment, procedural treatments include surgical and endoscopic fundoplication with and without hiatal hernia repair, endoscopic antireflux mucosectomy with or without plication, and escalation to esophagectomy in complicated refractory disease.