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. 2017 Feb;17(1):22-28.
doi: 10.7861/clinmedicine.17-1-22.

Peroral endoscopic myotomy: a literature review and the first UK case series

Shraddha Gulati  1 , Andrew Emmanuel  1 , Haruhiro Inoue  2 , Bu'Hussain Hayee  1 , Amyn Haji  1
Affiliations

Peroral endoscopic myotomy: a literature review and the first UK case series

Shraddha Gulati et al. Clin Med (Lond). 2017 Feb.

Abstract

Peroral endoscopic myotomy (POEM) is an established treatment for primary achalasia. It has gained endorsement from the American Society for Gastrointestinal Endoscopy with increasing clinical acceptance since the first procedure, performed in Japan in 2008. The first successful POEM in the UK was performed in November 2013 at King's College Hospital and this article presents the first UK case series. Prospective data were collected at 3 and 12-24 months for consecutive patients undergoing POEM. Post-POEM gastro-oesophageal reflux health-related quality of life scale (GORD-HRQoL) score was recorded. Statistical comparisons were made using paired non-parametric testing. In an initial series of 33 consecutive prospectively followed patients (12 female; 49.5±13 years; median follow-up 9 (3-28) months; 58% having had previous intervention), a 91% success rate has been achieved at 3 months. To date, 16 patients have reached the 12-month time point, with 13 (81%) sustaining response. This case series compares well with international cohorts and demonstrates excellent long-term safety and favourable efficacy.

Keywords: Achalasia; endoscopy; manometry; oesophageal motility disorders.

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Figures

Fig 1.
Fig 1.
A – Barium swallow radiograph illustrating classical ‘bird beak’ appearance in achalasia; B – high resolution manometry illustrating the most common subtype, type II achalasia.
Fig 2.
Fig 2.
Schematic diagram of POEM procedure.  A – mucosal entry; B – creation of submucosal tunnel; C,D – myotomy; E – closure of mucosal entry. Reproduced with permission from Inoue et al.
Fig 3.
Fig 3.
EndoFLIP® pre- and post-myotomy. A – Pre-myotomy gastro-oesophageal junction diameter 5.4 mm; B – post-myotomy gastro-oesophageal junction diameter 12.8 mm.
Fig 4.
Fig 4.
A – pre- and 3 month post-POEM Eckardt score (n=32); B – pre- and post-POEM Eckardt score at 3 and 12–24 months (n=16); C – pre- and post-POEM 4-second integrated lower oesophageal pressure (n=9). POEM = peroral endoscopic myotomy
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