Abstract

Introduction: Per Oral endoscopic myotomy (POEM) has been accepted as minimal-invasive, endoscopic treatment option for long-term treatment of all types and stages of esophageal achalasia. The aim of the present study is to report our experience from 100 successful consecutive POEMs in Greek patients including complex achalasia patients.

Patients and Methods: We report on 100 consecutive patients with manometricaly proved esophageal achalasia (26 patients type Ι, 41 type ΙΙ, 33 type ΙΙΙ, and 21 with sigmoid esophagus), age range 17-92-years, mean age 55-years, 59 males, successfully treated by POEM from 2013-2019. Eckardt score was 7-12 (type ΙΙΙ). POEMs were performed under general anesthesia with intubation, according to previous description. During POEM CO₂ insufflation was obligatory used, while the ΤΤ-J knife was the main knife used in all POEM procedures and in all POEM stages. Eckardt score, esophagogram and manometry before and after POEM was used for evaluation of our results. POEM time was 45-130 mins. Follow-up was one month to six years. 

Results: Selective circular myotomy 10-22 cm in length was successfully completed in all patients, without severe acute or late complications. Twelve (12%) showed moderate pneumomediastinum and pneumoperitoneum, which was successfully managed by abdominal needle drainage during procedure. Five patients, during our first 20 POEMs, had severe intratunnel bleeding, which was successfully controled by coaggrasper, two patients had small mucosal injuries immediately recognised and successfully closed by clips and two patients showed mild pleural collection treated conservatively. Finally outcome was uneventful without any further clinical concequences. No other short or long-term serious complications were reported. Patients were discharged after one to three days hospitalization. During the follow-up one month to six years after POEM procedure all patients are alive, the majority (90%) had complete clinical improvement of their severe symptoms, while five patients successfully treated by redo- POEM in short term, which finally solved the problem, while in another five patients with complete dysphagia (3 with failed Heller, 2 octogenarians with sigmoid megaesophagus), POEM resulted in moderate improvement of dysphagia, however sufficient to maintain adequate nutrition for five years post-POEM. Erosive esophagitis was reported in 7%. 

Conclusions: Our results are in accordance to international data and proved the safety and efficacy of POEM as long-term treatment of all types of achalasia, including complex achalasia patients, end-stage sigmoid type achalasia and failure of all other previous therapies and failed Heller. In all these cases, POEM was the only realistic therapeutic option, gave solution in long-term, where all other treatments failed or contra-indicated.

Keywords: Achalasia, Heller Myotomy; Per-Oral Endoscopic Myotomy (POEM); Complex Achalasia; Submucosal Endoscopy; HRTM

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Citation

Citation: Nikolas Eleftheriadis., et al. “100 Successful Consecutive Peroral Endoscopic Myotomies (POEMs) for Long-Term Treatment of Esophageal Achalasia Including Complex Achalasia Patients. The Greek Experience”. Acta Scientific Gastrointestinal Disorders 3.3 (2020): 04-08.

Copyright

Copyright: © 2020 Nikolas Eleftheriadis., et al.This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.