Retrospective analysis of Peroral Endoscopic Myotomy (POEM) for the treatment of Achalasia at Ordensklinikum Linz
Author(s): Rafael Wiedmer Chaparro, Teresa Fritz, Georg Spaun, Alexander Ziachehabi, Rainer Schöfl
Background: Peroral endoscopic myotomy (POEM) is a minimally invasive procedure for treatment of achalasia. We analyze success, complications and learning curve in a consecutive series in our hospital.
Patients and Methods: Our retrospective analysis comprises all patients with achalasia, who were treated from 2015 until 2018 with POEM. Preoperative evaluation was done with history, high resolution manometry, EGD and video-cinematography. Reevaluation was performed six weeks after POEM with EGD and a history was taken. 43 patients were treated with POEM, 22 (52%) females, 21 (49%) males. The mean age was 55 (17-84) years. Six patients (14%) had been treated with injection of botulinum toxin, 12 patients (28%) with balloon dilatation before. According to Chicago classification 30 patients (85.7%) suffered from type II, four patients (11%) from type III and two patients (6%) from type I. The mean length of myotomy was 8.5±0.5cm and was extended 2cm beyond the gastroesophageal junction.
Results: In 36 procedures with complete data the initial success rate was 92%, defined as Eckardt Score ≤3. Three patients (8%) suffered from recurrent symptoms later. Eckardt Score was reduced from 7.0±0.3 to 1.0±0.2 after POEM (p<0,0001). We observed five complications (11%), which resolved with conservative treatment. Sufficient information on postinterventional reflux disease was only available from 24 patients: seven patients (29%) had a new erosive esophagitis, two patients reported typical symptoms without esophagitis. The complication rate decreased within four years from 25% to 0. A similar phenomenon was observed with recurrencies (learning curve).
Conclusion: Peroral endoscopic myotomy is an effective and safe method for the treatment of achalasia. The learning curve is relatively flat.