Initial Experience with Per Oral Endoscopic Myotomy (POEM) for Treatment of Achalasia

Kevin D Helling, MD, Shushmita Ahmed, MD, Candidate, Eric Leroux, MD, MBA, Candidate, Brian Sung, MD, Homero Rivas, MD, MBA, FACS, FASMBS

Stanford University Medical Center, Palo Alto, California

Introduction: Per oral endoscopic myotomy (POEM) is a novel procedure for treatment of esophageal achalasia. We report our initial experience with the first five POEM procedures performed at our institution.

Methods and Procedures: Preparation to perform POEM procedures was undertaken by using a combination of didactic study, observation, and simulation on animal and fresh human cadaveric specimens. These procedures were done under an IRB protocol.

Each procedure was performed using the technique described by Professor Haruhiro Inoue. All of the patients had a 10 cm myotomy extending from 7-8 cm proximal to the GE junction to 2-3 cm into the cardia of the stomach. Endoscopic examination at the conclusion of each procedure was performed to evaluate for injury or perforation, as well as for adequacy of the myotomy in improving passage of the endoscope into the stomach.

All patients were admitted to the hospital following the procedure. A gastrograffin swallow study was performed for each patient on post-operative day #1.

Results: Patient data is presented in table 1.

Table 1

PatientAgeGenderLength of Operation (min)Subjective Symptom ReliefIntraoperative Complications

No intraoperative complications were experienced. Mean and median operative times were 121 and 99 minutes, respectively. Upper GI swallow study on post-operative day #1 demonstrated smooth passage of contrast through the esophagus into the stomach in each patient. All patients were highly satisfied and with objective relief of dysphagia.

Conclusions: Per oral endoscopic myotomy is safe and effective for treatment of esophageal achalasia. With increased experience of the entire surgical team, case efficiency improved. Our patients each left the hospital reporting symptom relief and fast recovery times. POEM is an excellent alternative to other surgical treatments for esophageal achalasia as demonstrated by our initial five cases.

Session: Poster Presentation

Program Number: P587

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