Peroral endoscopic myotomy (POEM) for the treatment of achalasia: A multicenter Middle Eastern experience

• Published in: Saudi journal of gastroenterology Vol. 28; no. 1; pp. 74 - 79
• Main Authors: Al Lehibi, Abed, Elkholy, Shaimaa, Gouda, Mohamed, Al Dabbagh, Ammar, Al Balkhi, Areej, Almtawa, Abdullah, Al Otaibi, Nawwaf, El-Sherbiny, Mohammed, Essam, Kareem, Alzahrani, Mohammed, Al Ghamdi, Ahmed, Al Ghamdi, Adel, AlEid, Ahmad, Qutub, Adel, Alamr, Abdulrahman, Ahmad, Shameem, Al Sayari, Khalid, Al Ibrahim, Bashaar, Al Khathlan, Abdullah, Alkhiari, Resheed
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.01.2022; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow
• Subjects: Achalasia; Adolescent; Adult; Aged; Aged, 80 and over; Care and treatment; Child; Complications and side effects; Endoscopy; Esophageal Achalasia - surgery; Esophageal Sphincter, Lower - surgery; Esophagoscopy - methods; Female; Humans; Methylene blue; Middle Aged; Myotomy - methods; Natural Orifice Endoscopic Surgery - adverse effects; Natural Orifice Endoscopic Surgery - methods; Original; Retrospective Studies; Treatment Outcome; Young Adult; Middle East; Achalasia; surgical myotomy; Peroral endoscopic myotomy (POEM)
• ISSN: 1319-3767; 1998-4049; 1998-4049
• DOI: 10.4103/sjg.sjg_49_21

Background: Peroral endoscopic myotomy (POEM) was proposed in 2010 as a minimally invasive procedure for the treatment of achalasia. In this article, we describe the Middle Eastern experience with the procedure in terms of efficacy, length of admission, and short- and long-term complications. Methods: A retrospective analysis of our prospectively collected data on patients who underwent a POEM procedure was conducted between March 2019 and May 2020. The primary outcome was clinical success rate, defined as a postprocedure Eckardt score ≤3 at ≥3 months. Secondary outcomes included the length of hospital stay, presence of reflux symptoms or need for proton pump inhibitors (PPIs) ≥3 months, and adverse events. Results: During the study period, 67 patients (35 females) underwent the procedure for achalasia. The participants' ages ranged from 11 to 80 years (mean 41 ± 18 years). Eckardt scores before the treatment ranged between 4 and 12 (mean 8.85 ± 1.75). Sixty-four patients (95.5%) achieved Eckardt scores of ≤3 at ≥3 months after the procedure (95% confidence interval [CI]: 91%-100%). The difference between pre- and post-procedural Eckardt scores averaged around -8 points (95% CI: −7.5 to -8.5 P < 0.0001). Adverse events were reported in 24 patients (35.8%) and included pneumoperitoneum (32.8%), reflux symptoms at 3 months (29.9%), and surgical emphysema (3%). Six patients had adverse events that led to prolongation of admission; 3% of whom had aspiration pneumonia, 3% had pneumoperitoneum, 1.5% had both, and 1.5% had an esophageal tear. Conclusions: POEM is a promising procedure for the treatment of achalasia with a high clinical success rate, short hospital admission, and a reassuring safety profile.