Endoscopy 2019; 51(04): 350-354
DOI: 10.1055/a-0802-8826
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Feasibility of the peroral endoscopic myotomy (POEM) procedure with a new small-caliber endoscope (thin-POEM) in patients with achalasia

Oscar Víctor Hernandez Mondragón
1  Department of Endoscopy, Specialties Hospital, National Medical Center Century XXI, Mexico City, Mexico
,
Marina Alejandra González Martínez
1  Department of Endoscopy, Specialties Hospital, National Medical Center Century XXI, Mexico City, Mexico
,
Omar Michel Solórzano Pineda
1  Department of Endoscopy, Specialties Hospital, National Medical Center Century XXI, Mexico City, Mexico
,
Juan Manuel Blancas Valencia
1  Department of Endoscopy, Specialties Hospital, National Medical Center Century XXI, Mexico City, Mexico
,
María Luisa Hernández Reyes
2  Division of Gastroenterology and Hepatology, National Medical Center Century XXI, Mexico City, Mexico
› Author Affiliations
Further Information

Publication History

submitted 12 May 2018

accepted after revision 10 October 2018

Publication Date:
10 January 2019 (eFirst)

Abstract

Background Peroral endoscopic myotomy (POEM) is a recognized technique for patients with achalasia. We aimed to evaluate the feasibility of using a small-caliber endoscope (thin-POEM) to perform POEM in patients with achalasia.

Methods Naïve or previously treated patients were included between February 2016 and April 2018. A small-caliber (5.9 mm) nasoendoscope was used, with a modified closure method using cyanoacrylate. Strict follow-up was performed.

Results 45 patients were included, aged 45.5 years (interquartile range [IQR] 22 – 69); 53 % (24/45) had type II achalasia. Median total time for thin-POEM was 54 minutes (IQR 37 – 77) and median myotomy length was 13.5 cm (IQR 6 – 20). Results pre-procedure and 3 months post were Eckardt score 10 vs. 1 (P < 0.001), integrated relaxation pressure (IRP) 25.3 vs. 8.5 mmHg (P < 0.001), and timed barium esophagram (TBE) 100 % severely delayed vs. 86 % normal (P < 0.001), respectively. Type III patients had the longest thin-POEM times (median 58 minutes [IQR 52 – 77]). Reflux was confirmed at 3 months clinically in 17 % of patients, endoscopically in 20 %, and on pH monitoring in 53 %. At 6 months and 12 months, 40 % and 33 % of patients remained positive on pH monitoring and were medically managed.

Conclusions Thin-POEM seems to be a safe, effective, and efficient procedure for POEM in patients with achalasia, with good short-term follow-up results.