Peroral endoscopic myotomy of achalasia. A single center experience of 50 surgeries

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OBJECTIVE

The purpose of the study is evaluation of peroral endoscopic myotomy (POEM) of patients with esophageal achalasia in one center.

MATERIAL AND METHODS

Peroral endoscopic myotomy in 50 patients (20 — men, 30 — women) with achalasia during 4 years period (2017—2020) was performed. The duration of the age ranged from 15 to 72 years (mean 49.55±12.88 years). The disease duration ranged from 6 month to 40 years (mean 6.7±5.0 years). Endoscopic treatment was performed in 18 cases (balloon dilatation of cardia in 17, laparoscopic Heller myotomy in 1) before POEM. The mean of Eckardt score was 11.12±0.75.

RESULTS

In all cases, the interventions were completed endoscopically. The average duration of surgery was 113.06 min. The average length of the myotomy was 10.5 cm. The structure of intraoperative complications was dominated by carboxyperitoneum (15patients). Bleeding during the intervention was in 2 patients, 1 case was carboxythorax and 1 case was mucosa perforation. In the postoperative period, complications were diagnosed in 2 patients (bleeding and hematoma, partial necrosis of the mucosa along the formation of the tunnel). Patients were examined in clinic in terms of 1 month to 3 years after operation. In all cases, they regard their condition as satisfactory. Food oral intake was restored in all cases, 15 showed an increase in body weight. The average mark on the Eckardt scale was 1.48±0.98 points. Among the complaints: heartburn (12), difficulty swallowing solid food (3), feeling of a «foreign body» in the esophagus (3), regurgitation of liquid (2) were noticed. Endoscopic examination of grade A erosive esophagitis was diagnosed in 12 patients, grade B in 5, grade C in 1.

CONCLUSION

POEM in achalasia is high effective and safe intervention to improve the patient’s condition. The frequency of intra- and postoperative complications does not exceed the data of many other studies, and their severity and nature made it possible to eliminate them using endoscopic technologies. The higher incidence of gastroesophageal reflux and erosive esophagitis is an unpleasant aspect of oral endoscopic myotomy is compared with other minimally invasive interventions, which requires further analysis of the immediate and distant results of this intervention.

Keywords:

achalasia

endoscopy

peroral endoscopic myotomy

esophagus

complications

Authors:

Drobayzgin E.A.

Novosibirsk State Medical University;
Novosibirsk State Regional Clinical Hospital;
Meshalkin National Medical Research Center

ORCID: 0000-0002-3690-1316

Chikinev Yu.V.

Novosibirsk State Medical University;
Novosibirsk State Regional Clinical Hospital

ORCID: 0000-0002-6795-6678

Arkhipov D.A.

State Novosibirsk Regional Clinical Hospital

Tzoy A.P.

Center for Personalized Medicine LLC

Received:

11.01.2021

Accepted:

15.02.2021

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