Peroral endoscopic myotomy for esophageal achalasia: report of 42 cases

Abstract

To evaluate the efficacy and the feasibility of peroral endoscopic myotomy (POEM) for esophageal achalasia (AC). The clinical data of 42 patients diagnosed as AC and received POEM in the Zhongshan Hospital of Fudan University between August 2010 and March 2011 were reviewed retrospectively. The key procedures of POEM included esophageal mucosal incision, submucosal "tunneling" by endoscopic submucosal dissection(ESD) technique, endoscopic myotomy of the circular muscle, and closure of mucosal incision by hemostatic clips. The mean age of 42 cases was 43.9(range 10-70) years. The mean duration of disease was 8.7 years (range, 3 months to 50 years). The mean operative time was (68.5 ± 25.5) (range 23-180) minutes with a mean submucosal tunneling length of(10.5 ± 1.5)(range 8-15) cm. The average length of endoscopic myotomy of inner circular muscle was(9.5 ± 2.5)(range 7-13) cm. No serious complications related to POEM were encountered. The median follow-up period was 2.5(range 1-6) months. Dysphagia symptom was relieved significantly during the follow-up period in 41 patients; one patient had dysphagia and vomiting 15 days after the operation. Endoscopic observation showed a submucosal fistula which was managed by endoscopic incision. As a novel minimally invasive therapy for AC, POEM appears to have definite short-term outcomes and can rapidly alleviate dysphagia symptom. Further observations and long follow-up are needed to evaluate long-term outcome and complications.