Per-oral endoscopic myotomy relieves achalasia

Last Updated: 2015-05-05

By Will Boggs MD

NEW YORK (Reuters Health) - Per-oral endoscopic myotomy (POEM) is safe and effective for treating achalasia, researchers from Japan report.

"In our series there is no serious complication, and the success rate reaches approximately 95%," Dr. Haruhiro Inoue, from Showa University, Northern Yokohama Hospital, told Reuters Health by email.

Dr. Inoue and colleagues reported their experience with 500 consecutive achalasia patients from 2008 through 2013. Operation times averaged 90 minutes (range, 70.8 to 119), and the median total length of the endoscopic myotomy was 14.0 cm (11.0 cm in the esophagus and 3.0 cm in the stomach).

The short-term success rate was 91% (386/423), as measured by improvements in Eckardt score, though two-thirds of patients had endoscopic findings of reflux esophagitis.

Among 370 patients followed for one to two years after POEM, improvements in symptoms and lower esophageal sphincter pressure persisted, with an overall success rate of 91%. One in five patients complained of heartburn or regurgitation.

For the 61 patients followed for three or more years, the success rate was 88.5%, with no increase in reports of heartburn or regurgitation.

Sixteen patients (3.2%) had adverse events related to POEM, according to the April 10 Journal of the American College of Surgeons online report, but none of them prevented successful completion of the POEM procedure.

Patients were discharged four to five days after POEM.

The researchers emphasize that "POEM should be performed by experienced endoscopists to avoid complications or unfavorable outcomes."

"A key to a successful POEM procedure is complete dissection of circular muscle at the level of the lower esophageal sphincter," Dr. Inoue said.

"I recommend intensive observation of good performance of POEM surgery in a high-volume center," Dr. Inoue said. "Before starting your clinical practice of POEM I (advise) you to see at least 20 cases, because there are lots of variations in achalasia. Animal lab training is also mandatory."

Dr. Inoue said that POEM should "definitely" be the standard treatment for symptomatic achalasia. "In our institute so far, 900 consecutive achalasia patients (400 more cases after submission of this article) received POEM surgery with excellent results."

Dr. Toshitaka Hoppo from the Allegheny Health Network in Pittsburgh, Pennsylvania has used POEM to treat a variety of esophageal motility disorders. He told Reuters Health by email, "I totally agree that POEM is a reasonable approach to treat not only achalasia but also non-achalasia esophageal spastic disorders."

"POEM is no longer experimental," Dr. Hoppo concluded. "POEM is equivalent to laparoscopic approach in terms of safety and efficacy."

SOURCE: http://bit.ly/1IerCJR

J Am Coll Surg 2015.