{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T00:42:39Z","timestamp":1794444159562,"version":"4.9.1"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e0 degli Studi di Padova","id":[{"id":"https:\/\/ror.org\/00240q980","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Current therapeutic options for esophageal achalasia (EA) include pneumatic dilation (PD), laparoscopic Heller\u2013Dor myotomy (LHD), and peroral endoscopic myotomy (POEM), which has gained increasing popularity over the last decade. However, symptoms persist or recur after POEM in 10\u201320% of cases. Evidence on management of POEM failures is limited to small case series. This study evaluates the outcome of LHD in patients who previously underwent endoscopic treatment\u2014POEM or PD\u2014as compared to treatment-na\u00efve patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive patients with EA who underwent LHD between 2020 and 2025 were prospectively recorded. The study population was divided in three groups: treatment-na\u00efve (NA group), prior POEM (POEM group), and prior PD (PD group). Primary outcomes were morbidity, mortality, and therapeutic success. Secondary outcomes included postoperative IRP and postprocedural reflux. Treatment failure was defined as the persistence or reoccurrence of an Eckardt score\u2009&gt;\u20093 or the need for retreatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 577 patients were included: 498 in the NA group, 15 in the POEM group and 64 in the PD group. Intraoperative mucosal perforation occurred similarly (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.65). No mortality was recorded. The median follow-up was 30\u00a0months (IQR: 22\u201334). Treatment success was significantly lower after prior POEM (80%) compared with na\u00efve (98.6%) and PD group (95.3%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Abnormal postoperative acid exposure was more frequent after prior POEM (33.3%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). In selected patients with recurrence, endoscopic ultrasound revealed marked esophageal wall fibrosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LHD is safe and effective even after failed endoscopic therapy. However, patients previously treated with POEM represent a higher-risk subgroup with lower success rates and increased reflux.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-13278-3","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:22:07Z","timestamp":1787167327000},"page":"9748-9754","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Laparoscopic Heller\u2013Dor as salvage therapy after failed POEM: a prospective comparative study"],"prefix":"10.1007","volume":"40","author":[{"given":"Irene Sole","family":"Zuin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommaso","family":"Garbo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Provenzano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Forattini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Capovilla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Santangelo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arianna","family":"Vittori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Pittacolo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Nezi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Ghisa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edoardo Vincenzo","family":"Savarino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Moletta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loredana","family":"Nicoletti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Valmasoni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3281-0361","authenticated-orcid":false,"given":"Renato","family":"Salvador","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"},{"role":"corresponding-author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"13278_CR1","doi-asserted-by":"publisher","DOI":"10.1093\/dote\/doae024","author":"EV Savarino","year":"2024","unstructured":"Savarino EV, Salvador R, Ghisa M, Mari A, Forattini F, Costantini A, De Giorgio R, Zaninotto G (2024) Research gap in esophageal achalasia: a narrative review. 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E.V.S. has served as speaker for Abbvie, Aboca, Abivax, Agave, AGPharma, Alfasigma, Apoteca, Biosline, CaDiGroup, Celltrion, Dr Falk, EG Stada Group, Eli Lilly, Fenix Pharma, Galapagos, Giuliani, Johnson&Johnson, JB Pharmaceuticals, Innovamedica\/Adacyte, Lionhealth, Malesci, Mayoly Biohealth, Montefarco, Novartis, Omega Pharma, Pfizer, Rafa, Reckitt Benckiser, Recordati, Sandoz, Sanofi\/Regeneron, SILA, Takeda, Tillots, Unifarco, and has served as consultant for Abbvie, Alfasigma, Apogee, AstraZeneca, Biogen, Bristol-Myers Squibb, Celltrion, Dr. Falk, Eli Lilly, Fenix Pharma, Ferring, Giuliani, Grunenthal, Johnson&Johnson, JB Pharmaceuticals, Merck & Co, Nestl\u00e8, Pfizer, PRO.MED.CS Praha a.s., Reckitt Benckiser, Recordati, Sanofi\/Regeneron, SILA, Takeda, Unifarco; he received research support from Bonollo, Difass, Pfizer, Reckitt Benckiser, Sanofi\/Regeneron, SILA, Unifarco, Zeta Farmaceutici. Irene Sole Zuin, Tommaso Garbo, Luca Provenzano, Francesca Forattini, Giovanni Capovilla, Matteo Santangelo, Arianna Vittori, Matteo Pittacolo, Giulia Nezi, Matteo Ghisa, Lucia Moletta, Loredana Nicoletti, Michele Valmasoni has no conflicts of interest or financial ties to disclose.","order":1,"name":"Ethics","label":"Disclosures","group":{"name":"EthicsHeading","label":"Declarations"}}]}}