Haruhiro Inoue1, Hiroki Sato2, Haruo Ikeda2, Manabu Onimaru2, Chiaki Sato2, Hitomi Minami2, Hiroshi Yokomichi3, Yasutoshi Kobayashi4, Kevin L Grimes5, Shin-ei Kudo2. 1. Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama, Japan. Electronic address: haruinoue@yahoo.co.jp. 2. Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama, Japan. 3. Division of Medicine, Graduate School Department of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan. 4. Kobayashi Internal Medicine Clinic, Kobe, Japan. 5. Digestive Disease Center, Showa University, Koto Toyosu Hospital, Tokyo, Japan.
Abstract
BACKGROUND: After the first case of per-oral endoscopic myotomy (POEM) at our institution in 2008, the procedure was quickly accepted as an alternative to surgical myotomy and is now established as an excellent treatment option for achalasia. This study aimed to examine the safety and outcomes of POEM at our institution. STUDY DESIGN: Per-oral endoscopic myotomy was performed on 500 consecutive achalasia patients at our institution between September 2008 and November 2013. A review of prospectively collected data was conducted, including procedure time, myotomy location and length, adverse events, and patient data with short- (2 months) and long-term (1 and 3 years) follow-up. RESULTS: Per-oral endoscopic myotomy was successfully completed in all patients, with adverse events observed in 3.2%. Two months post-POEM, significant reductions in symptom scores (Eckardt score 6.0 ± 3.0 vs 1.0 ± 2.0, p < 0.0001) and lower esophageal sphincter (LES) pressures (25.4 ± 17.1 vs 13.4 ± 5.9 mmHg, p < 0.0001) were achieved, and this persisted at 3 years post-POEM. Gastroesophageal reflux was seen in 16.8% of patients at 2 months and 21.3% at 3-year follow-up. CONCLUSIONS: Per-oral endoscopic myotomy was successfully completed in all cases, even when extended indications (extremes of age, previous interventions, or sigmoid esophagus) were used. Adverse events were rare (3.2%), and there were no mortalities. Significant improvements in Eckardt scores and LES pressures were seen at 2 months, 1 year, and 3 years post-POEM. Based on our large series, POEM is a safe and effective treatment for achalasia; there are relatively few contraindications, and the procedure may be used as either first- or second-line therapy.
BACKGROUND: After the first case of per-oral endoscopic myotomy (POEM) at our institution in 2008, the procedure was quickly accepted as an alternative to surgical myotomy and is now established as an excellent treatment option for achalasia. This study aimed to examine the safety and outcomes of POEM at our institution. STUDY DESIGN: Per-oral endoscopic myotomy was performed on 500 consecutive achalasiapatients at our institution between September 2008 and November 2013. A review of prospectively collected data was conducted, including procedure time, myotomy location and length, adverse events, and patient data with short- (2 months) and long-term (1 and 3 years) follow-up. RESULTS: Per-oral endoscopic myotomy was successfully completed in all patients, with adverse events observed in 3.2%. Two months post-POEM, significant reductions in symptom scores (Eckardt score 6.0 ± 3.0 vs 1.0 ± 2.0, p < 0.0001) and lower esophageal sphincter (LES) pressures (25.4 ± 17.1 vs 13.4 ± 5.9 mmHg, p < 0.0001) were achieved, and this persisted at 3 years post-POEM. Gastroesophageal reflux was seen in 16.8% of patients at 2 months and 21.3% at 3-year follow-up. CONCLUSIONS: Per-oral endoscopic myotomy was successfully completed in all cases, even when extended indications (extremes of age, previous interventions, or sigmoid esophagus) were used. Adverse events were rare (3.2%), and there were no mortalities. Significant improvements in Eckardt scores and LES pressures were seen at 2 months, 1 year, and 3 years post-POEM. Based on our large series, POEM is a safe and effective treatment for achalasia; there are relatively few contraindications, and the procedure may be used as either first- or second-line therapy.
Authors: Peter J Kahrilas; Albert J Bredenoord; Mark Fox; C Prakash Gyawali; Sabine Roman; André J P M Smout; John E Pandolfino Journal: Nat Rev Gastroenterol Hepatol Date: 2017-09-27 Impact factor: 46.802
Authors: Erin K Greenleaf; Joshua S Winder; Christopher S Hollenbeak; Randy S Haluck; Abraham Mathew; Eric M Pauli Journal: Surg Endosc Date: 2017-12-07 Impact factor: 4.584
Authors: Dustin A Carlson; Zhiyue Lin; Peter J Kahrilas; Joel Sternbach; Eric S Hungness; Nathaniel J Soper; Michelle Balla; Zoe Listernick; Michael Tye; Katherine Ritter; Jenna Craft; Jody D Ciolino; John E Pandolfino Journal: Am J Gastroenterol Date: 2016-10-04 Impact factor: 10.864