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Gastrointest Endosc. 2013 Jul;78(1):39-44. doi: 10.1016/j.gie.2013.01.006. Epub 2013 Feb 26.

Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia.

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1
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Abstract

BACKGROUND:

Pneumatic dilation and laparoscopic Heller myotomy improve parameters of esophageal function such as lower esophageal sphincter (LES) pressure, esophageal emptying, and esophagogastric junction (EGJ) distensibility.

OBJECTIVE:

To evaluate the effect of peroral endoscopic myotomy (POEM) on esophagogastric function.

DESIGN:

Prospective trial.

SETTING:

Endoscopy department at a university hospital.

PATIENTS:

All consecutive patients aged >17 years with achalasia and an Eckardt score of ≥3.

INTERVENTION:

Before and 3 months after POEM, 10 consecutive patients underwent esophageal manometry, timed barium esophagograms, and EndoFLIP as well as an EGD.

MAIN OUTCOME MEASUREMENTS:

Eckardt symptom score, LES resting pressure, centimeters of barium stasis, EGJ distensibility, and reflux esophagitis.

RESULTS:

Compared with scores before POEM, patient symptom scores were significantly reduced (1, interquartile range [IQR 0-1] vs 8 [IQR 4-8]; P = .005). LES pressure decreased significantly (6.0 mm Hg [IQR 2.6-7.4] vs 19.0 mm Hg [IQR 13.0-28.0]; P = .008). Esophageal emptying increased significantly, and a 5-minute barium column measured 2.3 cm (IQR 0-3.2 cm) versus 10.1 cm (IQR 5.7-10.8 cm; P = .005). EGJ distensibility increased significantly (6.7 mm(2)/mm Hg [IQR 3.8-16.6] vs 1.0 mm(2)/mm Hg [IQR 0.4-2.3]; P = .02) at 50 mL. In 6 of 10 patients, reflux esophagitis was seen. Of these patients, 3 reported reflux symptoms.

LIMITATIONS:

Small number of patients, short-term follow-up.

CONCLUSION:

POEM improves esophagogastric function and suggests favorable long-term results based on Eckardt score, esophageal manometry, esophageal emptying, and EGJ distensibility. Long-term follow-up of larger series will determine whether the high rate of reflux esophagitis affects the clinical application of POEM.

PMID:
23453184
DOI:
10.1016/j.gie.2013.01.006
[Indexed for MEDLINE]
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