BACKGROUND: Peroral endoscopic myotomy has been developed to provide a less invasive treatment for oesophageal achalasia compared to surgical cardiomyotomy. AIMS: To report our initial experience on feasibility, safety and clinical efficacy of peroral endoscopic myotomy. METHODS: Eleven patients (eight women, mean age 32, range 24-58) underwent an attempt at peroral endoscopic myotomy under general anaesthesia. After submucosal injection, a mucosal entry into the oesophageal submucosa, and a tunnel extending to the oesophagogastric junction and beyond into the stomach were created (total mean length: 15 ± 1.7 cm). Myotomy of the circular oesophageal and gastric muscle bundles was then achieved under direct vision (total mean length: 10.2 ± 2.8 cm). Haemostatic clips were used to close the mucosal entry. The Eckardt Score and manometry were used to evaluate the results. RESULTS: Peroral endoscopic myotomy could be completed in 10 out of 11 patients (91%). Mean procedure time was 100.7 min (range 75-140 min). No major complication occurred. Clinical success was achieved in all patients at 1-month follow-up (Eckardt Score 7.1 vs. 1.1, p=0). Lower oesophageal sphincter pressure decreased from 45.1 to 16.9 mm Hg (p=0). CONCLUSIONS: This initial experience with peroral endoscopic myotomy shows its safety and efficacy in the treatment of achalasia. Further studies are warranted to assess the long-term efficacy and to compare peroral endoscopic myotomy with other treatment modalities.
BACKGROUND: Peroral endoscopic myotomy has been developed to provide a less invasive treatment for oesophageal achalasia compared to surgical cardiomyotomy. AIMS: To report our initial experience on feasibility, safety and clinical efficacy of peroral endoscopic myotomy. METHODS: Eleven patients (eight women, mean age 32, range 24-58) underwent an attempt at peroral endoscopic myotomy under general anaesthesia. After submucosal injection, a mucosal entry into the oesophageal submucosa, and a tunnel extending to the oesophagogastric junction and beyond into the stomach were created (total mean length: 15 ± 1.7 cm). Myotomy of the circular oesophageal and gastric muscle bundles was then achieved under direct vision (total mean length: 10.2 ± 2.8 cm). Haemostatic clips were used to close the mucosal entry. The Eckardt Score and manometry were used to evaluate the results. RESULTS: Peroral endoscopic myotomy could be completed in 10 out of 11 patients (91%). Mean procedure time was 100.7 min (range 75-140 min). No major complication occurred. Clinical success was achieved in all patients at 1-month follow-up (Eckardt Score 7.1 vs. 1.1, p=0). Lower oesophageal sphincter pressure decreased from 45.1 to 16.9 mm Hg (p=0). CONCLUSIONS: This initial experience with peroral endoscopic myotomy shows its safety and efficacy in the treatment of achalasia. Further studies are warranted to assess the long-term efficacy and to compare peroral endoscopic myotomy with other treatment modalities.
Authors: Oscar M Crespin; Louis W C Liu; Ambica Parmar; Timothy D Jackson; Jemila Hamid; Eran Shlomovitz; Allan Okrainec Journal: Surg Endosc Date: 2016-09-15 Impact factor: 4.584
Authors: Toshitaka Hoppo; Shyam J Thakkar; Lana Y Schumacher; Yoshihiro Komatsu; Steve Choe; Amit Shetty; Sara Bloomer; Emily J Lloyd; Ali H Zaidi; Mathew A VanDeusen; Rodney J Landreneau; Abhijit Kulkarni; Blair A Jobe Journal: Surg Endosc Date: 2015-04-07 Impact factor: 4.584
Authors: Ezra N Teitelbaum; Lubomyr Boris; Fahd O Arafat; Frédéric Nicodème; Zhiyue Lin; Peter J Kahrilas; John E Pandolfino; Nathaniel J Soper; Eric S Hungness Journal: Surg Endosc Date: 2013-09-17 Impact factor: 4.584