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Surgical Endoscopy
Published in: Surgical Endoscopy 7/2018

01-07-2018

Per oral endoscopic myotomy: early experience and safety of a multispecialty approach

Authors: Evgeny V. Arshava, Raffaele J. Marchigiani, Henning Gerke, Rami El Abiad, Ronald J. Weigel, Kalpaj R. Parekh, John Keech

Published in: Surgical Endoscopy | Issue 7/2018

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Abstract

Background

Per oral endoscopic myotomy (POEM) has gained increasing popularity for treating achalasia. A multidisciplinary approach may allow safe and early adoption of POEM into clinical practice.

Materials and methods

We performed a retrospective review of our initial POEM cases. All procedures were performed by a team of interventional gastroenterologist and thoracic surgeon. We analyzed demographics, comorbidities, achalasia subtypes, length of hospital stay, duration of surgery, morbidity, mortality, length of myotomy, preoperative and postoperative Eckardt scores.

Results

Thirty-one consecutive patients underwent POEM during the 24-month period from January 2014 to December 2015. Eighteen patients (58%) had prior non-operative interventions. Average duration of follow-up was 9.6 months. Seventeen patients (66.8%) had follow-up of 12 months and longer. Average preoperative Eckardt score was 6.3 (3–10), median 6. Average postoperative Eckardt score was 1.4 (0–8), median 1, in 1 month and an average 2.2, median 1, in 1 year. Patients with type III achalasia were most refractory to treatment, while patients with type II had the best results. Average LOS was 1.3 days (1–5), median 1 day. Average DOS was 106 min (60–148), median 106. Average LOM was 13 cm (10–15), with median of 13 cm. We had one 30-day mortality secondary to coronary artery disease. Four patients had prior Heller myotomies and underwent a posterior myotomy during POEM, with outcomes similar to patients with no prior myotomy.

Conclusions

We demonstrated safety and efficiency of a multispecialty approach for achalasia with POEM with a low rate of complications.
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Metadata
Title
Per oral endoscopic myotomy: early experience and safety of a multispecialty approach
Authors
Evgeny V. Arshava
Raffaele J. Marchigiani
Henning Gerke
Rami El Abiad
Ronald J. Weigel
Kalpaj R. Parekh
John Keech
Publication date
01-07-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 7/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6056-9

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