BACKGROUND: Peroral endoscopic myotomy (POEM) is an innovative achalasia treatment procedure that involves myotomy of the lower esophageal sphincter through a submucosal tunneling approach, combining the efficacy of surgical myotomy with the benefit of being a less invasive treatment. At this time, no data are available of POEM in Portugal. This study aimed to examine the safety and short-term outcomes of POEM in a Portuguese center. METHODS: Fifty POEM were performed on 49 consecutive patients at our institution between January 2017 and January 2020. A prospective study of a consecutive series of patients was conducted, including procedure time, myotomy location and length, adverse events and clinical success. An Eckardt score of ≤3 after POEM was deemed as a successful outcome. Gastroesophageal reflux disease (GERD) was evaluated based on symptoms and on upper endoscopy, which was performed at 3-6 months postoperatively to check for reflux esophagitis. RESULTS: POEM was successfully completed in all cases: 70% (n = 35) were naïve and 30% (n = 15) had previous treatments. The mean procedure time was 73.4 ± 22.6 min (range 45-125 min). There were no major adverse events. Minor adverse events were rare (8%), and there was no perioperative mortality. The Eckardt score significantly decreased from 6.9 ± 2.4 preoperatively to 0.5 ± 1.0 postoperatively (p < 0.05). Overall clinical success was documented in 98, 98 and 95.2% at 1, 3 and 6 months, respectively. These short-term outcomes after POEM were independent of previous treatments. Symptomatic GERD was seen in 22.4% of patients. CONCLUSIONS: Our results confirm the safety and excellent short-term efficacy of POEM in a Portuguese center. This supports POEM as one of the first-line achalasia therapies in Portugal when performed by experienced operators.
BACKGROUND: Peroral endoscopic myotomy (POEM) is an innovative achalasia treatment procedure that involves myotomy of the lower esophageal sphincter through a submucosal tunneling approach, combining the efficacy of surgical myotomy with the benefit of being a less invasive treatment. At this time, no data are available of POEM in Portugal. This study aimed to examine the safety and short-term outcomes of POEM in a Portuguese center. METHODS: Fifty POEM were performed on 49 consecutive patients at our institution between January 2017 and January 2020. A prospective study of a consecutive series of patients was conducted, including procedure time, myotomy location and length, adverse events and clinical success. An Eckardt score of ≤3 after POEM was deemed as a successful outcome. Gastroesophageal reflux disease (GERD) was evaluated based on symptoms and on upper endoscopy, which was performed at 3-6 months postoperatively to check for reflux esophagitis. RESULTS: POEM was successfully completed in all cases: 70% (n = 35) were naïve and 30% (n = 15) had previous treatments. The mean procedure time was 73.4 ± 22.6 min (range 45-125 min). There were no major adverse events. Minor adverse events were rare (8%), and there was no perioperative mortality. The Eckardt score significantly decreased from 6.9 ± 2.4 preoperatively to 0.5 ± 1.0 postoperatively (p < 0.05). Overall clinical success was documented in 98, 98 and 95.2% at 1, 3 and 6 months, respectively. These short-term outcomes after POEM were independent of previous treatments. Symptomatic GERD was seen in 22.4% of patients. CONCLUSIONS: Our results confirm the safety and excellent short-term efficacy of POEM in a Portuguese center. This supports POEM as one of the first-line achalasia therapies in Portugal when performed by experienced operators.
Authors: Peter J Kahrilas; Albert J Bredenoord; Dustin A Carlson; John E Pandolfino Journal: Clin Gastroenterol Hepatol Date: 2018-04-24 Impact factor: 11.382
Authors: H Inoue; H Minami; Y Kobayashi; Y Sato; M Kaga; M Suzuki; H Satodate; N Odaka; H Itoh; S Kudo Journal: Endoscopy Date: 2010-03-30 Impact factor: 10.093
Authors: José Pedro Rodrigues; Pedro Barreiro; Iala Carina; Liliana Carvalho; Pedro Figueiredo; Cristina Chagas Journal: GE Port J Gastroenterol Date: 2018-02-13
Authors: Cynthia E Weber; Christopher S Davis; Holly J Kramer; Jeff T Gibbs; Lourdes Robles; Piero Marco Fisichella Journal: Surg Laparosc Endosc Percutan Tech Date: 2012-08 Impact factor: 1.719
Authors: Yuki B Werner; Bengt Hakanson; Jan Martinek; Alessandro Repici; Burkhard H A von Rahden; Albert J Bredenoord; Raf Bisschops; Helmut Messmann; Marius C Vollberg; Tania Noder; Jan F Kersten; Oliver Mann; Jakob Izbicki; Alexander Pazdro; Uberto Fumagalli; Riccardo Rosati; Christoph-Thomas Germer; Marlies P Schijven; Alice Emmermann; Daniel von Renteln; Paul Fockens; Guy Boeckxstaens; Thomas Rösch Journal: N Engl J Med Date: 2019-12-05 Impact factor: 91.245
Authors: Neil H Bhayani; Ashwin A Kurian; Christy M Dunst; Ahmed M Sharata; Erwin Rieder; Lee L Swanstrom Journal: Ann Surg Date: 2014-06 Impact factor: 12.969
Authors: Mouen A Khashab; Marcelo F Vela; Nirav Thosani; Deepak Agrawal; James L Buxbaum; Syed M Abbas Fehmi; Douglas S Fishman; Suryakanth R Gurudu; Laith H Jamil; Terry L Jue; Bijun Sai Kannadath; Joanna K Law; Jeffrey K Lee; Mariam Naveed; Bashar J Qumseya; Mandeep S Sawhney; Julie Yang; Sachin Wani Journal: Gastrointest Endosc Date: 2019-12-13 Impact factor: 9.427
Authors: Babu P Mohan; Andrew Ofosu; Saurabh Chandan; Daryl Ramai; Shahab R Khan; Suresh Ponnada; Douglas G Adler Journal: Endoscopy Date: 2020-01-20 Impact factor: 10.093