RESULTS AFTER FIVE YEARS OF POEM AT KLINIKUM AUGSBURG, GERMANY

Aims:

Achalasia refers to the lack of smooth muscle relaxation of the lower esophageal sphincter. Classic endoscopic therapy such as pneumatic dilatation and injection of botulinum toxin are often associated with a poor relief of symptoms as well as a high recurrence rate. Peroral endoscopic Myotomy (POEM) is a new endoscopic treatment for achalasia.

Methods:

Between March 2012 and November 2017 54 patients (male 24, female 30) underwent POEM in our institution. The mean age of the patients was 52 years. 5 patients (9%) had achalasia type 1, 47 (87%) achalasia type 2 and 2 patients (3,8%) achalasia type 3. POEM was performed under general anesthesia and lasted 144 minutes (range: 75 – 300 min).

Results:

Technical success could be reached in 52 of 54 patients, while in 2 cases myotomy could not be completed. The following complications were observed during or shortly after POEM: intraprocedural bleeding (2/54), skin emphysema (2/54

An average of two endoscopic controls was done after the procedure. Patients were followed up after two months, two years and five years with the Eckhart-Score, a manometry and a gastroscopy. During the follow-up period 5 patients (4 female, 1 male) suffered from recurrence of achalasia, all of them had achalasia type 2. Surgical treatment with Heller myotomy was necessary in 3 cases, while 2 patients underwent a second POEM. The fifth patient was treated by injection of botulinum toxin.

Conclusions:

In summary POEM seems to be a good alternative to surgical treatment, but further experience such as long term data are still needed.