Abstract
PurposePeroral endoscopic myotomy (POEM) is a new efficacious treatment option for achalasia. We propose to define “esophageal remodeling” as the functional restoration of the esophagus that involves decreased lower esophageal sphincter (LES) pressure, recovery of esophageal body peristalsis, and reduction of luminal diameter. The aim of this study was to investigate “esophageal remodeling” after POEM for achalasia.Materials and methodsWe analyzed data from a prospectively collected database of POEM subjects, which included preoperative and 2-month postoperative Eckardt symptom scores, and results from esophageal high resolution manometry (HRM) and barium esophagogram (BE). We recruited 23 patients (13 male; mean age: 53.9 years) whose preoperative and postoperative HRM and BE results were available, from among 30 patients with achalasia who underwent POEM at two institutions between July 2013 and December 2015.ResultsAll patients achieved clinical treatment success (Eckardt score≤3). Partial recovery of esophageal body peristalsis was noted in 1/5 patients with type I (20%), 6/11 with type II (54.5%), and 7/7 with type III (100%) achalasia after POEM. Pan-esophageal pressurization disappeared after POEM in 10/11 type II achalasia patients. The average diameter of the esophageal body after POEM was significantly decreased in all types of achalasia.ConclusionPOEM provided excellent clinical symptomatic relief and esophageal remodeling in terms of restoration of peristalsis and reduction in diameter of the esophageal body, especially in patients with type III achalasia.
Highlights
Achalasia is an esophageal motility disorder characterized by impaired deglutitive relaxation of the lower esophageal sphincter (LES) and absence of proper peristalsis of the esophageal body.[1]
Partial recovery of esophageal body peristalsis was noted in 1/5 patients with type I (20%), 6/11 with type II (54.5%), and 7/7 with type III (100%) achalasia after peroral endoscopic myotomy (POEM)
Pan-esophageal pressurization disappeared after POEM in 10/11 type II achalasia patients
Summary
Achalasia is an esophageal motility disorder characterized by impaired deglutitive relaxation of the lower esophageal sphincter (LES) and absence of proper peristalsis of the esophageal body.[1]. Peroral endoscopic myotomy (POEM) has emerged as a promising and minimally invasive surgical procedure that has demonstrated excellent short-term clinical outcomes.[3,4,5,6] Previous studies reported that POEM resulted in subjective clinical symptomatic relief but objective improvement of esophagogastric junction (EGJ) pressure measured by manometry.[3,4,5,6] In particular, POEM significantly decreased LES resting pressure and integrated relaxation pressure in most cases. [4,7,8]
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