Successful peroral endoscopic myotomy performed in Endoscopy Department as a radical, long-term treatment for esophageal achalasia – the Greek experience
Authors Eleftheriadis N, Eleftheriadou ED
Received 9 November 2016
Accepted for publication 14 January 2017
Published 14 February 2017 Volume 2017:13 Pages 185—190
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Akshita Wason
Peer reviewer comments 2
Editor who approved publication: Professor Garry Walsh
Nikolas Eleftheriadis,1,2 Eleni Damianos Eleftheriadou2
1Endoscopy Department, Gastroenterology Unit, Metropolitan Hospital Athens, 2Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
Introduction: Peroral endoscopic myotomy (POEM) has been considered as a minimal-invasive, innovative technique for long-term treatment of all types of esophageal achalasia and other esophageal motility disorders.
Patients and methods: We report on 20 consecutive Greek patients with manometrically proved esophageal achalasia (14 patients with type I, 4 with type II, 2 with type III, and 4 with sigmoid esophagus), with an age range of 32–92 years, mean age 59 years, 12 males, successfully treated by POEM from 2013 to 2015. The Eckardt score was 7–12 (type III). Seventeen (85%) POEM procedures were performed in the Endoscopy Department, according to a previous study. During POEM, CO2 insufflation was mandatory, while the Triangle Tip knife was the only knife used in all procedures. Eckardt score, esophagogram and manometry before and after performing POEM were used for evaluation of our results. The follow-up period was 6 months to 3 years.
Results: Selective circular myotomy, 10–13 cm in length, was successfully completed in all patients without severe acute or late complications. Three patients (15%) showed moderate pneumomediastinum and pneumoperitoneum, which was successfully managed by abdominal needle drainage during the procedure. One patient showed mild pleural collection, and in one patient the clip–endoloop technique was used to successfully close the mucosal entry after the completion of POEM. The outcome was uneventful without any further clinical consequences. No other short- or long-term serious complications were reported. Patients were discharged after 1–3 days of hospitalization. Six months to 3 years after the POEM procedure, all patients were alive; the majority (90%) had complete clinical improvement, while two patients with sigmoid-type achalasia showed moderate-to-significant clinical improvement. Erosive esophagitis was reported in 15%.
Conclusion: Our results are in accordance with international data, and proved the safety and efficacy of the POEM technique for radical long-term treatment of all types of achalasia, including end-stage sigmoid-type achalasia, in the Endoscopy Department. However, long-term follow-up is necessary and awaited.
Keywords: achalasia, Heller myotomy, peroral endoscopic myotomy
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