Peroral Endoscopic Myotomy in Patients with Type III Achalasia and Non Achalasia Esophageal Motility Disorders.

Abstract

Background : Achalasia is a disease characterized by dysphagia, regurgitation, chest pain, and weight loss. It is now classified into three subtypes according to the Chicago classification. Type III achalasia is characterized by lower esophageal sphincter obstruction with premature or spastic distal esophageal contractions. The aim of this study is to evaluate the efficiency of peroral endoscopic myotomy (POEM) in patients with type III achalasia as well as non achalasia esophageal motility disorders. Methods : This pilot prospective observational study was carried out on 12 patients aged from 18 to 75 years old, both sexes, with achalasia type III and non-achalasia esophageal motility disorders. Follow up after 3 months of Peroral Endoscopic Myotomy was evaluated by Eckardt score. Results : There is significant decrease in mean Eckardt score after Peroral Endoscopic Myotomy (9.83 vs 1.17, P < 0.001) as t-test showed (t-test 13.23 with 95% CI 7.23- 10.11). Thus, the effect of POEM on reducing Eckardt score is statistically significant. During the operative procedure, the average length of myotomy measured 20.42 cm, with a mean operative duration of 55.33 minutes. Following a mean follow-up period of 15.83 months, the mean Eckardt score decreased to 1.17. Bleeding occurred during the procedure in three cases (25%), while mucosal injury was observed in only one case. Additionally, one case experienced postoperative chest infection. Conclusions : Peroral Endoscopic Myotomy is safe and effective intervention in the management of achalasia type III as well as non-achalasia esophageal motility disorders