Abstract
BackgroundPer oral endoscopic myotomy (POEM) has been reported to be a new therapeutic option for esophageal achalasia. The possibility that POEM could reduce the risk of developing esophageal squamous cell carcinoma was evaluated.MethodsThis was a single-centre, retrospective study. Fifteen consecutive patients with esophageal achalasia who underwent POEM in our institution between August 2010 and January 2012 were enrolled. Ultra-high magnification with endocytoscopy was performed, and both histopathological and immunohistochemical evaluations for Ki-67 and p53 were assessed before and 3 months after POEM.ResultsPOEM was successfully performed and effectively released the dysphagia symptom in all patients without severe complications. Subjective symptoms (mean Ekcardt score, before 7.4 vs. after 0.5, p<0.05) and manometric pressure studies (mean lower esophageal sphincter pressure), before 82.7 vs. after 22.9 mmHg, p<0.05) showed substantial improvement following POEM. The average numbers of esophageal epithelial nuclei before and after POEM on endocytoscopic images were 128.0 and 78.0, respectively (p<0.05). The mean Ki-67-positive ratio was 26.0 (median 25.4, range, 10.3-33.2) before and 20.7 (median 20.0, 13.1-29.9; p=0.07) after POEM, and the mean p53-positive ratio was 2.35 (median 2.61, 0.32-4.23) before and 0.97 (median 1.49, 0.32-1.56; p<0.05) after POEM. A significant positive correlation was seen between the number of nuclei and the Ki-67-positive ratio (p<0.05).ConclusionsPOEM appears to be an effective and less invasive treatment of choice against achalasia and may reduce the risk of esophageal carcinogenesis. Endocytoscopy can be useful for the assessment of esophageal cellular proliferation.
Highlights
Per oral endoscopic myotomy (POEM) has been reported to be a new therapeutic option for esophageal achalasia
Patients Fifteen consecutive cases of esophageal achalasia which underwent POEM in our institution between August 2010 and January 2012 were enrolled in this study
The manometry study could not be completed in case 15 before POEM because the measuring catheter did not pass through the narrow segment of the esophagus
Summary
Per oral endoscopic myotomy (POEM) has been reported to be a new therapeutic option for esophageal achalasia. The possibility that POEM could reduce the risk of developing esophageal squamous cell carcinoma was evaluated. Persistent esophageal distension with retention of foods and fluids, bacterial overgrowth, and impaired clearance of regurgitated acid and gastric contents lead to chronic inflammation and passively cause dysplasia and carcinoma [3,4,5]. The aim of therapy is to reduce food stasis, which might interrupt the progression to carcinoma and reduce the risk of squamous cell carcinoma. In 1872, Fagge reported the first case of esophageal carcinoma developing in a patient with achalasia [6]. Meijssen et al reported that the risk of developing squamous cell carcinoma in achalasia patients was increased 33-fold over that in the general population [8]. Many investigators have warned clinicians about the high incidence of carcinogenesis in achalasia [9], the prognosis of patients who develop such carcinomas remains poor
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