Effectiveness and safety of peroral endoscopic myotomy in patients with achalasia

Abstract

Aim: This study aimed to present the outcomes in terms of efficacy and complications of the POEM procedure in adult patients diagnosed with achalasia and to investigate the potential effects of traditional risk factors such as age, gender, and obesity on these outcomes. Material and Methods: A total of 51 patients who underwent a POEM procedure were retrospectively evaluated from January 2021 to July 2023. The main outcome measured was the rate of clinical success, determined by achieving an Eckardt score of 3 or lower two months after the procedure. Secondary outcomes involved any adverse events, ICU admissions, and the presence of reflux symptoms at the two-month post-procedure mark. Results: The mean age of the patients was 49.3 ± 13.3 years, and the duration of symptoms ranged between 6 months and 10 years. Preoperative median Eckardt scores were 9, ranging between 5 and 12. At the 2nd month post-procedure, 96.1% of patients had an Eckardt score of 3 or lower, with a median reduction of 8 points (IQR = 6 – 8, p < 0.001). Among the patients, 13.7% encountered adverse events, comprising 3.9% with pneumomediastinum, 1.9% with mediastinitis, and 1.9% with intra-tunnel bleeding. At the 2nd month post-procedure, 17.6% of patients exhibited reflux esophagitis. No mortality was observed in any of the patients. Conclusion: POEM is an effective, safe, and minimally invasive treatment for achalasia that represents a promising therapeutic option, offering symptomatic relief, improved quality of life, and boasting a high clinical success rate. Although a small percentage of patients experienced adverse events, these were manageable and did not result in mortality.