Outcome Of Peroral Endoscopic Myotomy (POEM) For Treatment Of Achalasia

AIM To study the efficacy,safety and clinical prognosis of POEM in the setting of prior endoscopic interventions,and for children and adolescents achalasia.METHODS We reviewed the data of 75 cases of AC patients who underwent POEM from May 2011 to June 2014 at our Digestive Endoscopic Center and the complications that arose during the operation, after the operation, and symptoms of dysphagia (Eckardt score) during follow-up were analyzed; Patients were scheduled for a follow-up visit at 1 month after POEM for TBS (timed barium swallow, adults) and the diameter of the esophagus (esophageal barium, children and adolescents); They also underwent follow-up EGD at 1,3,6 and 12 months after POEM and annually thereafter to view the healing of the wound and to check any objective sign of reflux esophagitis(addition of standard 24-h pH if necessary), Patients were contacted via telephone every 3 months postoperatively to assess for reflux complications and to obtain a current Eckardt score. A final checkup was performed in December 2014. At that time, follow-up data for 93.3% of the patients were available for evaluation with 5 patient lost follow-up.RESULTS A total of 75 patients underwent POEM for treatment of AC. POEM was successfully completed in all patients. With 15 adverse events (20%) occurred: mucosal perforation 3 cases (4%),13 cases of gas-related complications (17.3%),1 case of simultaneous occurrence of gas-related complications and perforation, average blood loss<10 mL. No serious complications related to POEM such as delayed bleeding or mediastinal emphysema were encountered. There were significant differences (P<0.05) between pre and postoperative Eckardt score,barium height and diameter of the esophagus at 1 month post-POEM; during a follow-up of 6month-3 years,there are 5 cases were lost to follow-up,other appeared an improvement in the life quality of patients,75%(53/70) of patients gained weight by an average of 3.7 kg (1-7 kg); 1 and 2 patients experienced eating choking symptoms at 3 and 6 months respectively, after a single endoscopic balloon dilatation (EPD), both Eckardt ratings of patients were 0, and the dysphagia reliefed with no reflux.CONCLUSION Our initial experience suggests:POEM as an effective and safe platform for AC patients,provides a logical therapeutic modality, including in the setting of prior endoscopic intervention,also in children and adolescents, but further evaluation and long-term data are mandatory for a more confirmed conclusion.