Peroral endoscopic myotomy as an effective and safe treatment for achalasia: The authors’ experience and a literature review
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Background: Achalasia is a chronic esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter. The condition produces symptoms such as dysphagia, regurgitation, and an increased risk of esophageal cancer. Peroral endoscopic myotomy (POEM) has emerged as a minimally invasive, highly effective treatment, particularly beneficial for type III achalasia. This study evaluated the safety, efficacy, and clinical outcomes of POEM performed at our institution while examining factors associated with postoperative results. Methods: Seventeen consecutive achalasia patients who underwent POEM between September 2023 and March 2025 were retrospectively analyzed. Primary outcomes included changes in Eckardt scores, procedure duration, postoperative gastroesophageal reflux disease (GERD), and complication rates. Appropriate statistical tests—including the Wilcoxon signed-rank test, chi-square test, t -test, analysis of variance, and Pearson correlation coefficients—were utilized. Results: A significant clinical improvement was observed, with mean Eckardt scores markedly decreasing from 8.82 pre-POEM to 0.76 post-POEM (P < 0.001). Both technical and clinical success rates reached 100%. Postoperative GERD and non-erosive reflux disease occurred in 17.6% and 5.9% of patients, respectively, totaling 23.5%, with no significant correlation to achalasia type (P = 0.202). Notably, female patients demonstrated significantly better postoperative outcomes with lower Eckardt scores compared to males (P = 0.035). The overall complication rate was low (5.9%), and no significant relationships were identified between procedure duration or complication occurrence and the examined patient-specific factors. Conclusion: POEM is a safe, highly effective, and minimally invasive treatment for achalasia, yielding substantial symptomatic improvement, low complication rates, and excellent technical success. The observed sex-based differences in clinical outcomes warrant further investigation.
Abstract
Background: Achalasia is a chronic esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter. The condition produces symptoms such as dysphagia, regurgitation, and an increased risk of esophageal cancer. Peroral endoscopic myotomy (POEM) has emerged as a minimally invasive, highly effective treatment, particularly beneficial for type III achalasia. This study evaluated the safety, efficacy, and clinical outcomes of POEM performed at our institution while examining factors associated with postoperative results. Methods: Seventeen consecutive achalasia patients who underwent POEM between September 2023 and March 2025 were retrospectively analyzed. Primary outcomes included changes in Eckardt scores, procedure duration, postoperative gastroesophageal reflux disease (GERD), and complication rates. Appropriate statistical tests—including the Wilcoxon signed-rank test, chi-square test, t -test, analysis of variance, and Pearson correlation coefficients—were utilized. Results: A significant clinical improvement was observed, with mean Eckardt scores markedly decreasing from 8.82 pre-POEM to 0.76 post-POEM (P < 0.001). Both technical and clinical success rates reached 100%. Postoperative GERD and non-erosive reflux disease occurred in 17.6% and 5.9% of patients, respectively, totaling 23.5%, with no significant correlation to achalasia type (P = 0.202). Notably, female patients demonstrated significantly better postoperative outcomes with lower Eckardt scores compared to males (P = 0.035). The overall complication rate was low (5.9%), and no significant relationships were identified between procedure duration or complication occurrence and the examined patient-specific factors. Conclusion: POEM is a safe, highly effective, and minimally invasive treatment for achalasia, yielding substantial symptomatic improvement, low complication rates, and excellent technical success. The observed sex-based differences in clinical outcomes warrant further investigation.