Per oral endoscopic myotomy: Another tool in the toolbox

Area of Science:

• Gastroenterology
• Surgical Innovation
• Esophageal Motility Disorders

Background:

• Achalasia treatment is evolving towards less invasive approaches.
• Per oral endoscopic myotomy (POEM) is an emerging technique for achalasia management.
• Understanding POEM's efficacy and safety profile is crucial.

Purpose of the Study:

• To evaluate the outcomes of per oral endoscopic myotomy (POEM) in a cohort of achalasia patients.
• To assess the safety and efficacy of POEM in improving achalasia symptoms.
• To understand POEM's role in the modern management of achalasia.

Main Methods:

• A retrospective review of 152 achalasia patients undergoing POEM from April 2014 to March 2018.
• Comparison of preoperative and 2-month postoperative Eckardt scores, integrated relaxation pressure, and timed barium esophagram.
• Analysis of operative time, length of stay, morbidities, and return to daily activity.

Main Results:

• POEM was successfully completed in 98% of patients with a median operative time of 96 minutes and 1-day length of stay.
• Significant improvements were observed in median Eckardt scores (6 to 0), lower esophageal sphincter pressure (22 to 6 mm Hg), and barium column height/width (P < .001).
• Common morbidities included mucosal perforation (1.3%) and bleeding (2.0%); mortality was zero. 49.5% experienced abnormal acid reflux post-procedure.

Conclusions:

• Per oral endoscopic myotomy (POEM) is a safe and effective treatment for achalasia, yielding significant symptom improvement.
• POEM demonstrates clear subjective and objective benefits for achalasia patients.
• High incidence of post-POEM acid reflux necessitates further investigation regarding long-term sequelae and patient selection.