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KMID : 0359020130460020161
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Korean Journal of Gastrointestinal Endoscopy
2013 Volume.46 No. 2 p.161 ~ p.167
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Peroral Endoscopic Myotomy for Treatment of Achalasia: Initial Results of a Korean Study
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Lee Byung-Hoo
Shim Kwang-Yeun
Bok Gene-Hyun
Cho Jun-Hyung
Lee Tae-Hee
Cho Joo-Young
Hong Su-Jin
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Abstract
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Background/Aims: Achalasia is a rare esophageal motility disorder. Recently, a novel endoscopic technique, peroral endoscopic myotomy (POEM), was introduced as an alternative treatment for achalasia. We report the results and short term outcomes of POEM for patients with achalasia.
Methods: POEM was performed in 13 patients with achalasia. The procedure consisted of creating a submucosal tunnel followed by endoscopic myotomy of circular muscle bundles. The mucosal entry was closed by conventional hemostatic clips. A validated clinical symptom score (Eckardt score) and high resolution manometry were used to evaluate the outcomes.
Results: Both the clinical score of achalasia, as well as the resting lower esophageal sphincter (LES) pressure, were significantly reduced after POEM. Mean posttreatment Eckardt score was 0.4±0.7, compared to 6.4±1.9 prior to the treatment (p=0.001). The mean pretreatment and posttreatment LES pressure was 30.3 and 15.3 mm Hg, respectively (p=0.007). Following POEM, symptomatic relief from dysphagia without reflux symptoms was observed in all patients (13/13). No serious complications related to POEM were encountered.
Conclusions: Based upon our initial experience, the authors believe that POEM is a feasible, safe, and effective treatment and may possibly substitute established treatments of refractory achalasia.
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KEYWORD
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Esophageal achalasia, Peroral endoscopic myotomy, High resolution manometry
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