BACKGROUND: POEM is a recently developed achalasia treatment method, which combines the efficacy of surgical myotomy with the benefits of endoscopic procedures. Very few studies have focussed on the efficacy and usefulness of POEM in over 100 cases. METHODS: The first 100 adult patients treated according to standard POEM technique in a single center and followed up for 3 months were identified and included in this study (men 42; women 58; mean age 48.2 ± 18.8; range 9-91 years) The pre- and postoperative assessments included Eckardt scores, manometry, endoscopy, and monitoring pH. RESULTS: Mean operative time was 150.8 ± 49.3 min (75-370 min). Adverse events over Grade IIIb by the Clavien-Dindo classification were not encountered. The mean preoperative and postoperative lower esophageal sphincter pressures were 43.6 ± 26.2 and 20.9 ± 12.7 mmHg, respectively, indicating a statistically significant decrease after POEM (P < 0.05). The mean preoperative and postoperative integrated relaxation pressure values were 33.5 ± 15.2 and 15.3 ± 6.5 mmHg (P < 0.05). Furthermore, the Eckardt score significantly decreased from 5.9 ± 2.5 preoperatively to 0.8 ± 0.9 postoperatively (P < 0.05). Clinical success was documented in 99 % of the patients. Short-term outcomes after POEM were extremely good and independent of the age, type of achalasia, and previous treatment method. The percent of monitoring time with a pH < 4 was 25.6 % (22/86) in patients not on proton-pump inhibitors. Nine patients were diagnosed with symptomatic gastroesophageal reflux disease (GERD); patients with reflux esophagitis and symptomatic GERD improved with PPI treatment. CONCLUSIONS: Our results confirm the efficacy of POEM in a large patient series and support POEM as one of the first-line achalasia therapies in the near future.
BACKGROUND:POEM is a recently developed achalasia treatment method, which combines the efficacy of surgical myotomy with the benefits of endoscopic procedures. Very few studies have focussed on the efficacy and usefulness of POEM in over 100 cases. METHODS: The first 100 adult patients treated according to standard POEM technique in a single center and followed up for 3 months were identified and included in this study (men 42; women 58; mean age 48.2 ± 18.8; range 9-91 years) The pre- and postoperative assessments included Eckardt scores, manometry, endoscopy, and monitoring pH. RESULTS: Mean operative time was 150.8 ± 49.3 min (75-370 min). Adverse events over Grade IIIb by the Clavien-Dindo classification were not encountered. The mean preoperative and postoperative lower esophageal sphincter pressures were 43.6 ± 26.2 and 20.9 ± 12.7 mmHg, respectively, indicating a statistically significant decrease after POEM (P < 0.05). The mean preoperative and postoperative integrated relaxation pressure values were 33.5 ± 15.2 and 15.3 ± 6.5 mmHg (P < 0.05). Furthermore, the Eckardt score significantly decreased from 5.9 ± 2.5 preoperatively to 0.8 ± 0.9 postoperatively (P < 0.05). Clinical success was documented in 99 % of the patients. Short-term outcomes after POEM were extremely good and independent of the age, type of achalasia, and previous treatment method. The percent of monitoring time with a pH < 4 was 25.6 % (22/86) in patients not on proton-pump inhibitors. Nine patients were diagnosed with symptomatic gastroesophageal reflux disease (GERD); patients with reflux esophagitis and symptomatic GERD improved with PPI treatment. CONCLUSIONS: Our results confirm the efficacy of POEM in a large patient series and support POEM as one of the first-line achalasia therapies in the near future.
Authors: Mouen A Khashab; Ahmed A Messallam; Manabu Onimaru; Ezra N Teitelbaum; Michael B Ujiki; Matthew E Gitelis; Rani J Modayil; Eric S Hungness; Stavros N Stavropoulos; Mohamad H El Zein; Hironari Shiwaku; Rastislav Kunda; Alessandro Repici; Hitomi Minami; Philip W Chiu; Jeffrey Ponsky; Vivek Kumbhari; Payal Saxena; Amit P Maydeo; Haruhiro Inoue Journal: Gastrointest Endosc Date: 2015-01-26 Impact factor: 9.427
Authors: Ahmed M Sharata; Christy M Dunst; Radu Pescarus; Eran Shlomovitz; Aaron J T Wille; Kevin M Reavis; Lee L Swanström Journal: J Gastrointest Surg Date: 2014-09-03 Impact factor: 3.452
Authors: P H Zhou; Q L Li; L Q Yao; M D Xu; W F Chen; M Y Cai; J W Hu; L Li; Y Q Zhang; Y S Zhong; L L Ma; W Z Qin; Z Cui Journal: Endoscopy Date: 2013-02-06 Impact factor: 10.093
Authors: Lee L Swanstrom; Ashwin Kurian; Christy M Dunst; Ahmed Sharata; Neil Bhayani; Erwin Rieder Journal: Ann Surg Date: 2012-10 Impact factor: 12.969
Authors: John E Pandolfino; Monika A Kwiatek; Thomas Nealis; William Bulsiewicz; Jennifer Post; Peter J Kahrilas Journal: Gastroenterology Date: 2008-07-22 Impact factor: 22.682
Authors: Madhusudhan R Sanaka; Prashanthi N Thota; Malav P Parikh; Umar Hayat; Niyati M Gupta; Scott Gabbard; Rocio Lopez; Sudish Murthy; Siva Raja Journal: Surg Endosc Date: 2018-10-19 Impact factor: 4.584