The POEM bottom-up technique for achalasia.

Area of Science:

• Gastroenterology
• Surgical Innovation
• Endoscopic Procedures

Background:

• Per Oral Endoscopic Myotomy (POEM) is an established treatment for achalasia.
• Current POEM techniques primarily focus on a proximal-to-distal muscle fiber division.
• Existing methods have associated disadvantages that can be overcome with technique refinement.

Purpose of the Study:

• To introduce and evaluate the distal-to-proximal (bottom-up) POEM technique.
• To compare the safety, efficacy, and efficiency of the bottom-up technique against the standard POEM approach.
• To assess the impact of the bottom-up technique on patient outcomes and procedural metrics.

Main Methods:

• Retrospective analysis of a prospectively maintained database of achalasia patients undergoing POEM.
• Comparison of the initial 15 cases using the standard technique with 90 subsequent cases using the bottom-up technique.
• Evaluation of clinical presentation, operating time, adverse events, and post-procedure outcomes (Eckardt scores).

Main Results:

• Both techniques significantly improved Eckardt scores (p < 0.001).
• The bottom-up technique demonstrated a significantly shorter average procedure time (74.3 min vs. 111.2 min, p = 0.002).
• Fewer perioperative adverse events, including pneumoperitoneum and postoperative fever, were observed with the bottom-up technique.

Conclusions:

• The bottom-up POEM technique is an effective alternative for achalasia treatment.
• This technique is associated with improved safety, speed, and ease of performance compared to the standard method.
• The study recommends considering the bottom-up POEM technique for achalasia management.