Therapeutic effect of peroral endoscopic myotomy on esophageal achalasia

Abstract

Objective To evaluate the efficacy and safety of peroral endoscopic myotomy （POEM） for achalasia. Methods A total of 40 achalasia patients who underwent POEM at our hospital were enrolled. The outcomes of Eckardt score, Barium contrast imaging, esophageal manometry as well as esopha gogastroscopy were assessed before and at 6th day, 1 month, 3 months and 6 months after POEM respectively. Results All 40 patients successfully underwent POEM, with the mean operation time 57.2 ± 18. 4 minutes. Intraoperative mediastinal and subcutaneous emphysema occurred on two patients. All patients had significant symptom relief after POEM （ Eckardt score ≤ 3 ）. The patients had a mean follow-up of 13.3 months. Two patients had symptom relapse, and treatment success rate （Eckardt score ≤3） was 90% in 6-month follow up. According to high-resolution manometry （HRM）, the resting lower esophageal sphincter （LES） pressures were 30. 6 and 15.8 mmHg （ P = 0. 001 ）, and intergrated relaxation pressure （IRPs） were 28.1 and 12. 2 mmHg （P =0. 000） before and after POEM, respectively. The diameter of the esophageal lumen was 4. 2 cm and 3.1 cm before and after POEM （P 〈 0. 001 ）. Conclusion POEM is safe and effective in a short term with less complications. Further follow-up studies are needed to evaluate long-term outcomes. Key words: Esophageal achalasia; Manometry; Postoperative complications ; Peroral endo-scopie myotomy