Experience with Peroral Endoscopic Myotomy for Achalasia and Spastic Esophageal Motility Disorders at a Tertiary U.S. Center
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Background/Aims: Peroral endoscopic myotomy (POEM) is a novel procedure for the treatment of achalasia and spastic esophagealdisorders. Experience with POEM is limited, but its reported outcomes are excellent. It is deemed safe even for patients with priorinterventions. Methods: This retrospective review included patients who underwent POEM at a tertiary US center. POEM was performed in amultidisciplinary approach by advanced endoscopists and foregut surgeons. Clinical success was defined as a post-POEM Eckardt score ≤3. Results: A total of 125 patients were included. Median follow-up period was 18 months (interquartile range, 10–22 months). Clinicalsuccess was achieved in 92% of patients and persisted at 12 months in 88% of patients. Mucosal barrier failure (MBF) occurred in7 patients, 2 of whom required surgical intervention. MBF was more common in patients with prior laparoscopic Heller myotomy (19%vs. 3%, p=0.015). MBF requiring surgical intervention occurred early in the learning curve. Conclusions: POEM is safe and effective in the treatment of achalasia and spastic esophageal disorders even after failed priorinterventions.
Abstract
Background/Aims: Peroral endoscopic myotomy (POEM) is a novel procedure for the treatment of achalasia and spastic esophagealdisorders. Experience with POEM is limited, but its reported outcomes are excellent. It is deemed safe even for patients with priorinterventions. Methods: This retrospective review included patients who underwent POEM at a tertiary US center. POEM was performed in amultidisciplinary approach by advanced endoscopists and foregut surgeons. Clinical success was defined as a post-POEM Eckardt score ≤3. Results: A total of 125 patients were included. Median follow-up period was 18 months (interquartile range, 10–22 months). Clinicalsuccess was achieved in 92% of patients and persisted at 12 months in 88% of patients. Mucosal barrier failure (MBF) occurred in7 patients, 2 of whom required surgical intervention. MBF was more common in patients with prior laparoscopic Heller myotomy (19%vs. 3%, p=0.015). MBF requiring surgical intervention occurred early in the learning curve. Conclusions: POEM is safe and effective in the treatment of achalasia and spastic esophageal disorders even after failed priorinterventions.
참고문헌 (28)
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