Peroral Endoscopic Myotomy for Esophageal Achalasia: Outcomes of the First 100 Patients With Short term Follow up.
OBJECTIVE Aim of this study is to report the mid term outcomes of a large series of patients treated with peroral endoscopic myotomy (POEM) in a single European center. BACKGROUND POEM is a recently developed treatment of achalasia, which combines the efficacy of surgical myotomy, with the benefits of an endoscopic procedure. Previous studies, including few patients with a short term follow up, showed excellent results on dysphagia relief. METHODS The first 100 adult patients treated in a single tertiary referral center were retrospectively identified and included in this study (41 men, mean age 48.4 years) Patients were treated according to a standard technique. Follow up data, including clinical evaluation, and results of esophagogastroduodenoscopy (EGD) manometry, and pH monitoring were collected and analyzed. RESULTS POEM was completed in 94% of patients. Mean operative time was 83 minutes (49 140 minutes) No complications occurred. Patients were fed after a median of 2 days (1 4 days) A mean follow up of 11 months (3 24 months) was available for 92 patients. Clinical success was documented in 94.5% of patients. Twenty four hour pH monitoring documented Gastro Esophageal Reflux Disease (GERD) in 53.4% of patients. However, only a minority of patients had heartburn (24.3% or esophagitis (27.4% and these patients were successfully treated with proton pump inhibitors. CONCLUSIONS Our results confirm the efficacy of POEM in a large series of patients, with a mean follow up of 11 months. Should our results be confirmed by long term follow up studies, POEM may become one of the first line therapies of achalasia in the next future.
Annals of surgery