Per-oral endoscopic myotomy: a multi-centre New Zealand experience

Abstract

Background and aims: Per-oral endoscopic myotomy (POEM) is an established treatment for achalasia. We aim to review outcomes of all POEM cases performed in New Zealand for achalasia.

Methods: A retrospective review of all POEM procedures performed in the five hospitals offering POEM between November 2015 and December 2022 was undertaken. The primary outcome was clinical success, defined as Eckardt score ≤3. Secondary outcomes included procedural complications.

Results: One hundred and sixty-six index and four redo POEM procedures were performed by seven clinicians. Ninety-six (58%) were male and mean age was 49.6 years (standard deviation [SD] 19.2 years). Eighty-three (50%) had a previous achalasia intervention. Median length of hospital stay was 1 day (interquartile range [IQR] 1-2 days). Median pre-POEM Eckardt score was 8 (IQR 6-9) and improved to 0 (IQR 0-2) at 6 months (p<0.001). Technical success was achieved in 164 (99%). Clinical success was achieved in 124 (93%) at 6 months and sustained to 12 months in 37/42 (88%) of these patients with follow-up data. Clinical success was achieved in 92% who underwent any prior intervention. There were five reported complications: tunnel leak (three), significant pain (one) and pneumothorax (one). One tunnel leak required thoracotomy for empyema debridement, all other complications were managed conservatively. Forty-seven (31%) reported symptomatic reflux after POEM.

Conclusions: This first review of all POEM procedures performed in New Zealand for achalasia demonstrates high 6-month clinical success and safety for the management of achalasia.