Background
Peroral endoscopic myotomy (POEM) is a novel approach to performing esophageal myotomy
through a long submucosal tunnel.
Objective
This study aimed to investigate the feasibility and safety of POEM for treatment of
achalasia.
Design
Preclinical animal study and prospective clinical study.
Patients
Consecutive patients diagnosed with achalasia with high-resolution manometry.
Interventions
POEM was standardized for preclinical and clinical studies. After submucosal injection,
a mucosal incision was made 15 cm above the gastroesophageal junction (GEJ). A long
submucosal tunnel was created to extend below the GEJ. The endoscopic myotomy started
10 cm above and extended 2 cm below the GEJ. We first conducted a preclinical animal
study to confirm the safety of POEM. POEM was then performed for the treatment of
achalasia in humans.
Main Outcome Measurements
Relief from dysphagia assessed by the dysphagia score and Eckhardt score. High-resolution
manometry and pH monitoring were performed to evaluate the posttreatment effects and
esophageal acid exposure.
Results
Seven 30-kg porcine models underwent POEM in the survival study. All of the pigs survived
except 1, which sustained pneumomediastinum. POEM was performed for the treatment
of achalasia in 16 patients. The mean operating time was 117.0 ± 34.1 minutes. All
patients tolerated food on day 2, with a contrast study confirming no leakage. The
median follow-up was 176.5 days (range 98-230 days). The postoperative basal lower
esophageal sphincter pressure was significantly reduced (mean reduction, 13.9 ± 14.5
mm Hg; P = .005) and 4-second integrated relaxation pressure of the GEJ (mean reduction, 10.1
± 7.4 mm Hg; P = .001). Of these patients, 58.3% had a normalized 4-second integrated relaxation
pressure, whereas 20% had excessive esophageal acid exposure after the procedure.
There was a significant improvement in quality of life 6 months after POEM measured
by the Short Form-36 questionnaire.
Limitation
Small sample size.
Conclusions
POEM is a feasible, safe, and effective treatment for achalasia. (Clinical trial registration
number: NCT01525732.)
Abbreviations:
GEJ (gastroesophageal junction), HRM (high-resolution manometry), IRP (integrated relaxation pressure), LES (lower esophageal sphincter), POEM (peroral endoscopic myotomy)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 08, 2012
Accepted:
August 15,
2012
Received:
June 8,
2012
Footnotes
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: Drs Chiu and Lau served as members of a research group sponsored by Olympus. The other authors disclose no financial relationships relevant to this publication. The prototype triangle-tip knife was provided by Olympus Co Ltd at no cost.
If you would like to chat with an author of this article, you may contact Dr Chiu at [email protected]
Identification
Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
