Peroral endoscopic full-thickness myotomy for the treatment of sigmoid-type achalasia: outcomes with a minimum follow-up of 12 months.

OBJECTIVE: To explore the feasibility, safety, and efficacy of peroral endoscopic full-thickness myotomy (fPOEM) for the treatment of sigmoid-type achalasia.
METHODS: From August 2011 to June 2014, a total of 23 sigmoid-type achalasia patients received fPOEM at our hospital. Among these patients, 19 had sigmoid-type 1 achalasia and the other four had sigmoid-type 2 achalasia. Clinical data of general characteristics, procedure-related parameters and adverse events, symptom relief, and manometry outcomes before and during the periodic follow-up were retrospectively collected and analyzed.
RESULTS: All the patients successfully received fPOEM, with a mean procedure time of 67.6 min; six patients received a conventional fPOEM whereas the other 17 received a modified fPOEM. During a median follow-up of 18 months, the median Eckardt score decreased obviously (pre-POEM vs. post-POEM, 7.0 vs. 1.0, P<0.05), the mean lower esophageal sphincter pressures and 4s integrated relaxation pressure decreased (pre-POEM vs. post-POEM, 34.78±4.51 vs. 11.50±2.56 mmHg and 29.52±3.67 vs. 10.61±1.54 mmHg, P<0.01), and the esophageal diameter decreased (pre-POEM vs. post-POEM, 58.2±11.6 vs. 37.5±7.3 mm, P<0.05). Overall treatment success was achieved in 95.6% of the patients (22/23), and morphological improvement was observed in 95% (19/20) of the patients. In 10 patients (43.5%) complications were encountered, including gas-related complications, mucosal perforation, and reflux esophagitis. There was no significant difference in terms of efficacy between conventional fPOEM and modified fPOEM, but modified fPOEM may reduce the occurrence of gas-related complications.
CONCLUSION: fPOEM is feasible, safe, and effective for the treatment of sigmoid-type achalasia. A modified fPOEM may reduce the occurrence of gas-related complications. Yet, further experiences and long-term results are warranted.