Peroral endoscopic myotomy is expanding its indications: (j am coll surg 2013;217:598-605).

Abstract

Peroral endoscopic myotomy (POEM) is a novel non-surgical endoscopic procedure for treatment of achalasia, and has been performed as a primary therapy for achalasia with good short-term outcomes. Heller myotomy is a surgical therapy for treatment of achalasia and has a good long-term prognosis. However, symptoms of achalasia after Heller myotomy persist or recur with the rate of 3.5% to 15%.1 Recently, Onimaru et al2 have tested the feasibility of POEM as a rescue therapy in achalasia patients with persistent or recurrent symptoms after undergoing surgical myotomy. Of 315 patients receiving POEM in Showa University Northern Yokohama Hospital, 11 (3.5%) patients had been treated with surgical myotomy as a primary therapy. They had complained persistent or recurrent symptoms of achalasia. Of these 11 patients, 10 patients underwent POEM as a rescue therapy. In 10 patients at 3 months after POEM, lower esophageal sphincter resting pressure (22.1 ± 6.6 mmHg vs. 10.9 ± 4.5 mmHg) was significantly reduced, and Eckardt symptom scores (6.5 ± 1.3 vs. 1.1 ± 1.3) were also significantly improved. Adverse events related to POEM procedure in these patients were not reported.