Original articleClinical endoscopyEffect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia
Section snippets
Study design
This prospective, observational study was approved by the Medical Ethics Committee of the Academic Medical Centre, University of Amsterdam in Amsterdam (June 16, 2011, NCT01405469).
Patients
Adult patients with achalasia based on esophageal manometry and a patient symptom score of ≥3 were included in the study. Exclusion criteria included previous esophageal or gastric surgery, malignant or premalignant esophageal lesions, and a severe sigmoid-shaped esophagus.
Outcome measurements
Before and 3 months after POEM treatment,
Patients
Between August 2011 and January 2012, 10 patients (4 female) with a median age of 43 years (IQR 31-66 years) underwent a POEM procedure for symptomatic achalasia. Achalasia was established in all patients by using esophageal manometry, and all patients gave written, informed consent. Three patients (33.3%) had received achalasia treatment before. Two patients underwent up to 3 pneumatic dilation procedures, with a maximum balloon size of 40 mm, and 1 patient was treated 2 years before with a
POEM
The POEM procedure was safely performed in all patients. No technical difficulties occurred perioperatively. All patients were discharged after 3 days of hospital stay. The pretreatment median Eckardt score was 8 IQR 4-8 compared with a 3-month posttreatment score of 1 (0-1) (P = .005).
Discussion
In this study, we evaluated the effect of POEM on esophagogastric function parameters in patients with achalasia. All patients were successfully treated with regard to symptoms, in line with other reports.9, 10 This study is the first, however, that shows that POEM also significantly improved esophagogastric junction physiology as shown by decreased LES pressure, improved esophageal emptying, and improved EGJ distensibility.
Evaluation of esophagogastric function parameters is of great interest
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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
See CME section; p. 142.