A prospective multicentre study of per-oral endoscopic myotomy (POEM) for achalasia in Australia
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Published on: March 4, 2014
Sunil Gupta1,2, Mayenaaz Sidhu1,2, Xuan Banh3
1Westmead Hospital, Sydney, NSW.
Objective:
To describe the clinical and procedural outcomes of per-oral endoscopic myotomy (POEM) for achalasia in Australia.
Design, Setting:
Prospective observational study in three Australian tertiary referral centres, 5 May 2014 - 27 October 2019 (66 months).
Participants:
Patients who had undergone POEM for achalasia.
Major Outcome Measures:
Eckardt scores calculated prior to POEM and six months, one year, and two years after POEM. The primary outcome was clinical success, defined as an Eckardt score of 3 or less without a second intervention.
Results:
142 patients underwent POEM for achalasia; their mean age was 52 years (SD, 18 years), 83 were men (58%), and the median length of hospital stay two days (IQR, 1-3 days). Their mean Eckardt score before POEM was 8.0 (SD, 2.4) and 1.1 (SD, 1.6) six months after POEM; it did not change significantly between six months and two years after POEM (mean monthly increase, 0.014 points; 95% CI, -0.001 to 0.029). A total of 127 patients (89%) improved clinically after POEM. Intra-procedural capnoperitoneum was the only risk factor associated with treatment failure (adjusted hazard ratio, 2.85; 95% CI, 1.08-7.51). Previous treatments - botulinum toxin injection (25 patients, 18%), endoscopic balloon dilatation (69, 49%), and Heller myotomy (14, 10%) - did not affect POEM outcomes. Five patients (4%) experienced major adverse events, including pneumonia, oesophageal leak, empyema and melaena, that were managed during admission and without sequelae.
Conclusions:
POEM is an effective treatment for achalasia. Significant reductions in Eckardt scores achieved by six months are sustained at two years. POEM can be both a first line definitive therapy and a salvage therapy for patients not helped by other treatments.
