Short-term outcome and safety of peroral endoscopic myotomy for treating achalasia in a university hospital in Austria

Introduction Achalasia is a rare condition with a disturbed oesophageal peristalsis resulting in a failing relaxation of the lower oesophageal sphincter due to a degeneration of myenteric plexus. Peroral endoscopic myotomy (POEM) has increasingly become the preferred treatment option over laparoscopic Heller´s myotomy for treating achalasia.

Methods In this retrospective analysis we included all POEMs performed from March 2020 to May 2021 at Kepler University hospital. We assessed the short-term outcome both clinical and via barium swallow imaging. Furthermore we assessed the length of the myotomy, procedure-inherent complications, post-interventional level of C-reactive protein (CRP) and length of hospitalisation.

Results In total we performed 10 POEMs during the observational period. The mean age of patients was 53 years (range 16-75), 4 of 10 were male. The mean length of myotomy was 10,7 centimetres (range 7-15). The initial success rate (no dysphagia and a normal imaging) was 100 %. Complications happened in 5 cases (50 %), all of these were a pneumoperitoneum, which could be treated successful via cannulation. There was no need for surgery in any case. Perforations did not happen. The mean level of CRP on the post-procedure day was 4,05 mg/dl. Hospital dismission was possible in mean at day 3 (range 2-5). After a period of six weeks we did not observe reflux oesophagitis in any patient.

Conclusion POEM is a safe and effective procedure and preferred over Heller´s myotomy because of the advantages like minimal-invasiveness and a shorter need for hospitalisation. Short-term outcomes and safety in our hospital is comparable to published literature.

Publication History

Article published online:
01 September 2021