Fumiaki Yano, MD, Nobuo Omura, Kazuto Tsuboi, Masato Hoshino, Kazuhiro Sumiyama, Hiromasa Matsui, Se Ryung Yamamoto, Shunsuke Akimoto, Takahiro Masuda, Koji Nakada, Katsunori Nishikawa, Norio Mitsumori, Hideyuki Kashiwagi, Katsuhiko Yanaga. The Jikei University School of Medicine
Background and objective: In our institution, laparoscopic Heller-Dor procedure (LHD) has been the first-line surgical procedure for achalasia since the introduction in August 1994. In January 2016, per-oral endoscopic myotomy (POEM) was started, taking into patients’ needs into consideration. Since then, treatment options have expanded to include balloon dilation, conventional LHD, LHD by reduced port surgery (RPS), LHD by needlescopic surgery (NS), and POEM. Here, we report changes we have observed in surgical procedures since the introduction of POEM.
Subjects and methods: The subjects were 46 patients (mean age 47.5±14.0 years, 24 women) who underwent surgery for achalasia from January 2016 to May 2017. After explaining the advantages and disadvantages, the choice of surgical procedure was left up to the patient.
Results: The breakdown of the surgical procedures was LHD (including 1 RPS and 13 NS):POEM=31:15. While intraoperative complications (esophageal mucosal injury, injuring of esophageal longitudinal muscles) were observed in LHD and POEM one patient each, while dysphagia improved in all patients. Postoperative reflux esophagitis was observed in 5 patients with POEM (33%), which was significantly higher than 2 patients (6%) in LHD (p=0.0173). Moreover, all reflux esophagitis in each case was mild (Los Angeles classification: Grade A).
Conclusion: While one-third of patients underwent POEM, reflux esophagitis occurred at a higher rate in POEM as compared to LHD.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86374
Program Number: P727
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster