Acta Scientific Gastrointestinal Disorders (ISSN: 2582-1091)

Research Article Volume 3 Issue 3

100 Successful Consecutive Peroral Endoscopic Myotomies (POEMs) for Long-Term Treatment of Esophageal Achalasia Including Complex Achalasia Patients. The Greek Experience

Nikolas Eleftheriadis1-4, Haruhiro Inoue3, Haruo Ikeda3, Manabu Onimaru3, Nikolas Evgenides2, Ioanna Bravita2, Andreas Protopapas4, Eleni Eleftheriadou2, Grace Santi3, Theodora Kali5 and John Katsogridakis1

1Metropolitan Hospital Athens, Greece
2Euromedica Kyanous Stauros, Thessaloniki, Greece
3Digestive Diseases Center, Showa University, Koto Toyosu Hospital, Japan
41st Propedeutic Department of Internal Medicine, Endoscopy Department, AHEPA University Hospital, Greece
5Gastroenterology Unit, Larnaka General Hospital, Cyprus

*Corresponding Author: Nikolas Eleftheriadis, Gastroenterologist, Euromedica Kyanous Stauros, Thessaloniki, Greece.

Received: December 16, 2019; Published: February 11, 2020

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Abstract

Introduction: Per Oral endoscopic myotomy (POEM) has been accepted as minimal-invasive, endoscopic treatment option for long-term treatment of all types and stages of esophageal achalasia. The aim of the present study is to report our experience from 100 successful consecutive POEMs in Greek patients including complex achalasia patients.

Patients and Methods: We report on 100 consecutive patients with manometricaly proved esophageal achalasia (26 patients type Ι, 41 type ΙΙ, 33 type ΙΙΙ, and 21 with sigmoid esophagus), age range 17-92-years, mean age 55-years, 59 males, successfully treated by POEM from 2013-2019. Eckardt score was 7-12 (type ΙΙΙ). POEMs were performed under general anesthesia with intubation, according to previous description. During POEM CO2 insufflation was obligatory used, while the ΤΤ-J knife was the main knife used in all POEM procedures and in all POEM stages. Eckardt score, esophagogram and manometry before and after POEM was used for evaluation of our results. POEM time was 45-130 mins. Follow-up was one month to six years. 

Results: Selective circular myotomy 10-22 cm in length was successfully completed in all patients, without severe acute or late complications. Twelve (12%) showed moderate pneumomediastinum and pneumoperitoneum, which was successfully managed by abdominal needle drainage during procedure. Five patients, during our first 20 POEMs, had severe intratunnel bleeding, which was successfully controled by coaggrasper, two patients had small mucosal injuries immediately recognised and successfully closed by clips and two patients showed mild pleural collection treated conservatively. Finally outcome was uneventful without any further clinical concequences. No other short or long-term serious complications were reported. Patients were discharged after one to three days hospitalization. During the follow-up one month to six years after POEM procedure all patients are alive, the majority (90%) had complete clinical improvement of their severe symptoms, while five patients successfully treated by redo- POEM in short term, which finally solved the problem, while in another five patients with complete dysphagia (3 with failed Heller, 2 octogenarians with sigmoid megaesophagus), POEM resulted in moderate improvement of dysphagia, however sufficient to maintain adequate nutrition for five years post-POEM. Erosive esophagitis was reported in 7%. 

Conclusions: Our results are in accordance to international data and proved the safety and efficacy of POEM as long-term treatment of all types of achalasia, including complex achalasia patients, end-stage sigmoid type achalasia and failure of all other previous therapies and failed Heller. In all these cases, POEM was the only realistic therapeutic option, gave solution in long-term, where all other treatments failed or contra-indicated.

Keywords: Achalasia, Heller Myotomy; Per-Oral Endoscopic Myotomy (POEM); Complex Achalasia; Submucosal Endoscopy; HRTM

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References

  1. Inoue H., et al. “Peroral endoscopic myotomy (POEM) for esophageal achalasia”. Endoscopy 42 (2010): 265-271.
  2. Pandolfino JE., et al. “Achalasia: a new clinically relevant classification by high-resolution manometry”. Gastroenterology 135 (2008): 1526-1533.
  3. Shiwaku H., et al. “Successful treatment of diffuse esophageal spasm by peroral endoscopic myotomy”. Gastrointestinal Endoscopy 77 (2013): 149-150.
  4. Onimaru M., et al. “Greater curvature myotomy is a safe and effective modified technique in per-oral endoscopic myotomy (with videos)”. Gastrointestinal Endoscopy (2015).
  5. Eleftheriadis N., et al. “Successful peroral endoscopic myotomy for radical treatment of sigmoid-type esophageal achalasia by Greek gastroenterologists”. Annuals of Gastroenterology 27 (2014): 430-431.
  6. Zhou PH., et al. “Peroral endoscopic remyotomy for failed Heller myotomy: a prospective single-center study”. Endoscopy 45 (2013): 161-166.
  7. Onimaru M., et al. “Peroral endoscopic myotomy is a viable option for failed surgical esophagocardiomyotomy instead of redo surgical Heller myotomy: a single center prospective study”. Journal of American College of Surgeons 217 (2013): 598-605.
  8. Cappell MS., et al. “Updated Systematic Review of Achalasia, with a Focus on POEM Therapy”. Digestive Diseases and Sciences (2019).
  9. Kumbhari V., et al. “Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study”. Endoscopy International Open 3 (2015): E195-201.
  10. Costamagna G., et al. “Peroral endoscopic myotomy (POEM) for oesophageal achalasia: preliminary results in humans”. Digestive Liver Disease 44 (2012): 827-832.
  11. Bechara R., et al. “Peroral endoscopic myotomy (POEM) for complex achalasia and the POEM difficulty score”. Digestive Endoscopy 31 (2019): 148-155.
  12. Weche M., et al. “Revisional Procedures for Recurrent Symptoms After Heller Myotomy and Per-Oral Endoscopic Myotomy”. Journal of Laparoendoscopic and Advanced Surgical Techniques A (2019).
  13. Eleftheriadis N., et al. “Training in peroral endoscopic myotomy (POEM) for esophageal achalasia”. Therapeutics and Clinical Risk Management 8 (2012): 329-342.
  14. Stavropoulos SN., et al. “The International Per Oral Endoscopic Myotomy Survey (IPOEMS): a snapshot of the global POEM experience”. Surgical Endoscopy 27 (2013): 3322-3338.
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Citation

Citation: Nikolas Eleftheriadis., et al. “100 Successful Consecutive Peroral Endoscopic Myotomies (POEMs) for Long-Term Treatment of Esophageal Achalasia Including Complex Achalasia Patients. The Greek Experience”. Acta Scientific Gastrointestinal Disorders 3.3 (2020): 01-05.



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