Per oral endoscopic myotomy: early experience and safety of a multispecialty approach.

Abstract

Per oral endoscopic myotomy (POEM) has gained increasing popularity for treating achalasia. A multidisciplinary approach may allow safe and early adoption of POEM into clinical practice. We performed a retrospective review of our initial POEM cases. All procedures were performed by a team of interventional gastroenterologist and thoracic surgeon. We analyzed demographics, comorbidities, achalasia subtypes, length of hospital stay, duration of surgery, morbidity, mortality, length of myotomy, preoperative and postoperative Eckardt scores. Thirty-one consecutive patients underwent POEM during the 24-month period from January 2014 to December 2015. Eighteen patients (58%) had prior non-operative interventions. Average duration of follow-up was 9.6months. Seventeen patients (66.8%) had follow-up of 12months and longer. Average preoperative Eckardt score was 6.3 (3-10), median 6. Average postoperative Eckardt score was 1.4 (0-8), median 1, in 1month and an average 2.2, median 1, in 1year. Patients with type III achalasia were most refractory to treatment, while patients with type II had the best results. Average LOS was 1.3days (1-5), median 1day. Average DOS was 106min (60-148), median 106. Average LOM was 13cm (10-15), with median of 13cm. We had one 30-day mortality secondary to coronary artery disease. Four patients had prior Heller myotomies and underwent a posterior myotomy during POEM, with outcomes similar to patients with no prior myotomy. We demonstrated safety and efficiency of a multispecialty approach for achalasia with POEM with a low rate of complications.