Shota Maruyama1, Yusuke Taniyama2, Tadashi Sakurai2, Makoto Hikage2, Chiaki Sato2, Kai Takaya2, Takuro Konno2, Takeshi Naitoh2, Michiaki Unno2, Takashi Kamei2. 1Hachinohe City Hospital, 2Tohoku University Graduate School of Medicine
Introduction: Achalasia is a rare esophageal motility disorder and the treatment of this disease is directed at lowering the lower esophageal sphincter (LES) pressure, with the aim of reducing the functional obstruction to bolus transit at this site.
POEM is the procedure that cut an esophageal muscle using the endoscopy and it makes LES pressure lower. This procedure was first performed by Inoue in 2008, some reports was described the efficacy and safety for a straight type of achalasia.
On the other hand, an efficacy of POEM for patients with a sigmoid type of achalasia has been controversial. Because the sigmoid type of achalasia has not only high LES pressure but also morphological changes including dilation, swerve and rotation.
The aim of this study is to evaluate the safety and efficacy of POEM for patients with the sigmoid type of achalasia.
Methods and Procedures: Between May 2015 and December 2017, 16 patients with the sigmoid type of achalasia underwent POEM in our institute. POEM procedure was same for the straight type of achalasia, which was performed by anterior approach or posterior approach. Double scope technique was used to check the submucosal tunnel reached gastric side.
The primary endpoint was the therapeutic success at 2 months after POEM. Secondary endpoints comprised operation time, change of the esophageal angulation and adverse events before and after POEM.
Results: All patients were performed POME successfully. There were significant differences in Eckardt score, LES pressure and integrated relaxation pressure (IRP) in patients between before and after POEM (Eckardt score: before: 0.9, after: 0.4, p<0.01, LES pressure: before: 20.5, after: 11.3, p<0.01, IRP: before: 18.4, after: 9.7, p< 0.01). Average operation time was 94.7 (50-150) min. An esophageal angulation before POEM was 106 degrees and it was 124 degrees after POEM (P<0.001). Postoperative complications occurred in 4 patients. All patients were treated conservatively.
Conclusion: POEM appears to be an effective and safe option for the treatment of the sigmoid type of achalasia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94972
Program Number: S145
Presentation Session: Flexible Endoscopy II
Presentation Type: Podium
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