Per oral endoscopic myotomy for achalasia: A Taiwanese single‐center experience

Abstract

Endoscopic treatment of achalasia includes endoscopic botulinum toxin injection, endoscopic pneumatic dilations (PD) but surgery owns longer durability. Per oral endoscopic myotomy (POEM) carries high expectations with good short and mid‐term report and only minor morbidity in Western and Eastern countries outside Taiwan. The purpose of this study is to report a 2‐year clinical outcome and safety of POEM among a prospective registered achalasia cohort in southern Taiwan. We, retrospectively, analyzed 22 prospective registered patients who received POEM for achalasia, adhered and completed 2‐year regular follow‐up studies between July 2015 and December 2020 from Kaohsiung Chang Gung Memorial Hospital, Taiwan. Then, 22 of achalasia patients (8 males: 14 females) were enrolled into this study (male/female: 8/14, mean age: 45.0 years). All 22 patients had received high‐resolution manometry to diagnose and classify the phenotype. Fifteen patients were diagnosed as type I achalasia and seven as type II by Chicago classification. Clinical remission rates were 100% at 3 months, 6 months, 1 year, and 95.5% at 2 years. Four patients who recurred after previous PD were successfully treated with POEM with clinical remission. Three patients had fever after POEM. Two patients (9.1%) had gastroesophageal reflux disease (GERD) after POEM procedure. POEM is an effective and safe treatment of choice for achalasia with 95.5% of 2‐year clinical remission in this Taiwanese study. Post‐POEM GERD is low in the current study but the concern for potential GERD needs long‐term follow‐up reports to further clarify especially with larger scale quality studies.