Peroral Endoscopic Shorter Myotomy for the Treatment of Achalasia with Sigmoid-Esophagus: Our Preliminary Experience

Abstract

Introduction: Peroral endoscopic myotomy is a promising minimally invasive treatment for achalasia. It is also reported that this new therapy was effective for treating achalasia with sigmoid esophagus. The aim of the study was to examine the feasibility and safety of a novel modified peroral endoscopic shorter myotomy for sigmoid-type achalasia. Methods: Between July 2011 and August 2015, Eleven achalasia patients (6 male, with a mean age of 41 years) with sigmoid esophagus underwent peroral endoscopic shorter myotomy in our department. Diagnosis was based on symptoms, manometry, radiology and endoscopy. Preoperative and postoperative symptoms scores, manometry outcomes and quality of life scoring of achalasia were recorded and analyzed. Results: All patients had dysphagia as their chief presenting complaint with the median duration of 21 months (range 18-36 months). Procedure was performed successfully in all patients, and the mean time required for the procedure was 56.8 minutes (range 49-70 minutes) (Figure 1). There were no mortalities and major postoperative complications occurred. The mean length of myotomy was 5.2 cm (range 5-6 cm). During a mean follow-up period of 23 months (range 12-37.5 months), treatment success (Eckardt score ≤ 3) was achieved in all patients. There was a significant improvement of symptoms relief, lower esophageal sphincter pressure decrease and quality of life (P < 0.01, P < 0.01, P < 0.01, respectively). Symptoms of gastroesophageal reflux occurred in two patient, and it was easily controlled with regular doses of proton pump inhibitors.Figure 1Conclusion: In this study, peroral endoscopic shorter myotomy is feasible, effective and safe in improving subjective, objective, and quality-of-life outcome measures in patients with sigmoid-type achalasia. Further studies are warranted to prove its long-term efficacy in comparison to other treatment modalities.