Peroral endoscopic myotomy in patients with advanced achalasia: short- and long-term outcomes

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OBJECTIVE

To evaluate the immediate and long-term results of peroral endoscopic myotomy (POEM) in patients with stage IV esophageal achalasia (EA) in a single center.

MATERIAL AND METHODS

In 2017—2022 years peroral endoscopic myotomy in patients with advanced achalasia was performed in 16 cases (8 — men, 8 — women). The patients’ average age was 55 years. The disease duration was 18.23 years.

RESULTS

Technical success was achieved in 100%. The average duration of the intervention was 113 minutes. The average myotomy length was 13.2 cm. During the operation 1 (6.25%) patient had mucosal injury, 2 patients had carboxyperitoneum, and 1 (6.25%) had bleeding. All complications were treated endoscopically. Oral food and fluid intake was restored in all cases. Erosive esophagitis was diagnosed in 5 patients (grade A — 1, grade B — 3, grade C — 1). Therapy with proton pump inhibitors was effective in all patients. The spread of dysphagia according to the Eckadt scale in the period from 1 month to 1 year after surgery ranged from 0 to 5 points. According to the SF-36 and GIQLI questionnaires, over the period from 1 month to 1 year, all indicators were significantly higher in relation to the indicators before the operation.

CONCLUSION

POEM is safe and effective the treatment method of patients with advanced achalasia. Erosive reflux esophagitis is the only unfavorable moment in postoperative period. The quality of life after peroral endoscopic myotomy in the postoperative period, according to the SF-36, GIQLI and Eckardt scales, remains at a high level up to 1 year after the intervention. Further follow-up of patients in the postoperative period is required to assess more long-term results of the intervention.

Keywords:

achalasia

endoscopy

peroral endoscopic myotomy

esophagus

S-shape esophagus

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

Mitko N.I.

Novosibirsk State Medical University

ORCID: 0000-0002-6447-637X

Received:

16.01.2023

Accepted:

02.03.2023

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