Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Dec 8:36:e1784.
doi: 10.1590/0102-672020230066e1784. eCollection 2023.

PERORAL ENDOSCOPIC MYOTOMY FOR ACHALASIA: SAFETY PROFILE, COMPLICATIONS AND RESULTS OF 94 PATIENTS

Francisco Paulo Ponte Prado Junior  1 , Ivens Filizola Soares Machado  1 , Maria Paula Lopes Ponte Prado  2 , Renato Bruno Cavalcante Leite  1 , Samuel Magalhães Gurgel  1 , José Walter Feitosa Gomes  2 , José Huygens Parente Garcia  3
Affiliations
Observational Study

PERORAL ENDOSCOPIC MYOTOMY FOR ACHALASIA: SAFETY PROFILE, COMPLICATIONS AND RESULTS OF 94 PATIENTS

Francisco Paulo Ponte Prado Junior et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Background: Achalasia is an esophageal motility disorder, with clinical presentation of dysphagia and regurgitation. This is a chronic condition with no cure. Current treatment options aim to reduce lower esophageal sphincter tone by pharmacological, endoscopic or surgical means, with the aim of improving patients' symptoms. Peroral endoscopic myotomy (POEM) is an alternative endoscopic surgery to Heller cardiomyotomy, in which the procedure is performed orally, by endoscopy, offering efficacy comparable to surgical myotomy, with relative ease and minimal invasion, without external incisions.

Aims: To study the safety of POEM by analyzing its results, adverse events and perioperative complications and the main ways to overcome them, in addition to evaluating the effectiveness of the procedure and the short-term postoperative quality of life.

Methods: A qualitative and quantitative, observational and cross-sectional study that analyzed patients who underwent the POEM in a reference center, from December 2016 to December 2022, maintaining the technical standard of pre-, peri- and postoperative protocol.

Results: A total of 94 patients were included in the study, and only three had postoperative complications. The average early postoperative Eckardt score was 0.93 and the late 1.40, with a mean improvement of 7.1 in early results and 6.63 in late results (p<0.05).

Conclusions: POEM can be reproduced with an excellent safety profile, significant relief of symptoms and improvement in esophageal emptying, and in quality of life.

RACIONAL:: A acalasia é uma desordem da motilidade esofágica, com apresentação clínica de disfagia e regurgitação, uma condição crônica sem cura. As opções de tratamentos atuais visam reduzir o tônus do esfíncter esofagiano inferior (EEI) por meios farmacológicos, endoscópicos ou cirúrgicos, com o objetivo de aliviar os sintomas dos pacientes. A miotomia endoscópica peroral, sigla do inglês (POEM) é uma cirurgia endoscópica alternativa à cardiomiotomia a Heller (CH), em que a miotomia é realizada por via oral, por endoscopia, oferecendo eficácia comparável a miotomia cirúrgica, com relativa facilidade e mínima invasão, sem incisões externas.

OBJETIVOS:: Analisar a segurança do POEM analisando seus resultados, eventos adversos, complicações perioperatórias e suas principais formas de contorná-los, além de avaliar a eficácia do procedimento e a qualidade de vida pós-operatória, em curto prazo.

MÉTODOS:: Estudo qualitativo e quantitativo, observacional e transversal avaliando pacientes que realizaram o POEM em um centro de referência, entre dezembro de 2016 até dezembro de 2022, mantendo padrão técnico de preparo pré, peri e pós-operatório.

RESULTADOS:: Foram incluídos no estudo 94 pacientes e apenas 3 apresentaram complicações pós-operátorias. O escore de Eckardt médio precoce pós-operatório foi de 0,93 e o tardio de 1,40, com melhora média de 7,1 em resultados precoces e de 6,63 em resultados tardios (p<0,05).

CONCLUSÕES:: O POEM pode ser reproduzido com excelente perfil de segurança, alívio significativo dos sintomas e melhora do esvaziamento do esôfago, oferecendo melhora na qualidade de vida.

PubMed Disclaimer

Conflict of interest statement

Conflict of interests: None

Figures

Figure 1
Figure 1. Making a bubble in submucosa.
Figure 2
Figure 2. Excision of the mucosa.
Figure 3
Figure 3. Making the submucosa tunnel.
Figure 4
Figure 4. Myotomy.
Figure 5
Figure 5. Closure of the mucosal excision.
See this image and copyright information in PMC

References

    1. Akintoye E, Kumar N, Obaitan I, Alayo QA, Thompson CC. Peroral endoscopic myotomy: a meta-analysis. Endoscopy. 2016;48(12):1059–68. doi: 10.1055/s-0042-114426. - DOI - PubMed
    1. Boeckxstaens GE, Annese V, Varannes SB, Chaussade S, Costantini M, Cuttitta A, et al. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 2011;364(19):1807–16. doi: 10.1056/NEJMoa1010502. - DOI - PubMed
    1. Cappell MS, Stavropoulos SN, Friedel D. Updated systematic review of achalasia, with a focus on POEM therapy. Dig Dis Sci. 2020;65(1):38–65. doi: 10.1007/s10620-019-05784-3. - DOI - PubMed
    1. Copetti H, Copetti L, Copetti L, Felin GD, Felin GD, Felin CD, et al. Risk of preneoplastic lesions in mucosal projections of different sizes of the columnar epithelium in the lower esophagus. Arq Bras Cir Dig. 2022;35:e1674. doi: 10.1590/0102-672020220002e1674. - DOI - PMC - PubMed
    1. Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. 1992;103(6):1732–8. doi: 10.1016/0016-5085(92)91428-7. - DOI - PubMed

Publication types