{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:28:37Z","timestamp":1782908917936,"version":"3.54.5"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T00:00:00Z","timestamp":1732492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,7]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Gastroesophageal reflux disease (GERD) after peroral endoscopic myotomy (POEM) has been a limiting factor with POEM. Sling-fiber preservation during POEM was reported to reduce postoperative GERD in Japan. This study investigates the efficacy of this technique in a western population. This is a retrospective, single-center study of patients undergoing POEM from October 2017 to January 2023. The initial cohort of patients were treated by conventional POEM, after which a second cohort underwent POEM with sling-fiber preservation. The primary outcome was the incidence of postoperative reflux symptoms. The secondary outcomes were clinical success rate (Eckardt score\u00a0\u2264\u00a03), procedure time, and adverse events rate. Multivariate regression was then performed to identify factors associated with the incidence of postoperative reflux symptoms. One hundred and forty eight POEM cases (52.5\u2009\u00b1\u200915.6\u00a0y\/o, female: 61[43%]) were included. The mean procedure time (108.6\u2009\u00b1\u200934.5 vs. 109.1\u2009\u00b1\u200945.7\u00a0min, P\u2009=\u20090.93) was similar between the groups. In the sling-fiber preservation group, gastric myotomy length was significantly longer (2.2\u2009\u00b1\u20090.7 vs. 1.6\u2009\u00b1\u20090.8\u00a0cm, P\u2009&amp;lt;\u20090.05), yet the incidence rate of postoperative reflux symptoms at follow-up was significantly lower (22.4% vs. 42.3%, P\u2009&amp;lt;\u20090.05). The clinical success rate was similar between groups (89.5% vs. 83.1%, P\u2009=\u20090.32), and the rate of adverse events requiring intervention (13.5% vs. 12.2%, P\u2009=\u20090.36) was similar. Regression analysis indicated that, after adjusting for other risk factors of postoperative GERD, sling-fiber preservation during POEM had an odds ratio of 0.24 (95% CI: 0.07\u20130.85, P\u2009&amp;lt;\u20090.05) for the incidence of reflux symptoms. Sling-fiber preservation during POEM reduces the incidence of postoperative reflux symptoms. As such, sling-fiber preservation may be a useful solution to reduce post-POEM GERD in western populations.<\/jats:p>","DOI":"10.1093\/dote\/doae097","type":"journal-article","created":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T01:11:51Z","timestamp":1732583511000},"source":"Crossref","is-referenced-by-count":5,"title":["Sling fiber preservation during POEM reduces incidence of postoperative reflux symptoms"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5893-6552","authenticated-orcid":false,"given":"Yusuke","family":"Fujiyoshi","sequence":"first","affiliation":[{"name":"Division of Gastroenterology , St. Michael\u2019s Hospital, , Toronto, ON,","place":["Canada"]},{"name":"University of Toronto , St. Michael\u2019s Hospital, , Toronto, ON,","place":["Canada"]},{"name":"Department of Medicine , Division of Gastroenterology, The Ottawa Hospital, University of Ottawa, Ottawa, ON,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Raina Angeli","family":"Fujiyoshi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology , St. Michael\u2019s Hospital, , Toronto, ON,","place":["Canada"]},{"name":"University of Toronto , St. Michael\u2019s Hospital, , Toronto, ON,","place":["Canada"]},{"name":"Department of Medicine , Division of Gastroenterology, The Ottawa Hospital, University of Ottawa, Ottawa, ON,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5534-7533","authenticated-orcid":false,"given":"Kareem","family":"Khalaf","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology , St. Michael\u2019s Hospital, , Toronto, ON,","place":["Canada"]},{"name":"University of Toronto , St. Michael\u2019s Hospital, , Toronto, ON,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary R","family":"May","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology , St. Michael\u2019s Hospital, , Toronto, ON,","place":["Canada"]},{"name":"University of Toronto , St. Michael\u2019s Hospital, , Toronto, ON,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher W","family":"Teshima","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology , St. Michael\u2019s Hospital, , Toronto, ON,","place":["Canada"]},{"name":"University of Toronto , St. Michael\u2019s Hospital, , Toronto, ON,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,11,25]]},"reference":[{"issue":"8","key":"2025010911473893700_ref1","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1038\/ajg.2013.196","article-title":"ACG clinical guideline: diagnosis and management of achalasia","volume":"108","author":"Vaezi","year":"2013","journal-title":"Am 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