Analysis of the implementation of endoscopic treatment for achalasia using the POEM technique

Abstract

Description of the first cases of Peroral Endoscopic Myotomy (POEM) performed at Virgen del Rocio Hospital. The objective of the study is to assess outcomes, evaluate complications, and demonstrate treatment efficacy.

We prospectively analyzed treatment efficacy and complication occurrence at 3-6 months post-procedure. Changes in anthropometric parameters and symptom-related quality of life were considered, utilizing various subjective scales such as Eckardt, EAT-10, or MDADI.

The initial 26 cases from March '22 to October '23 were collected, including 3 type I achalasia, 21 type II, and 2 type III. One case had prior treatment with toxin, one with toxin and dilation, and another with dilation, the rest were treatment-naive. Mean age was 50 years.

Average intervention time was 86 minutes per procedure, with no notable incidents; Four pneumocenteses were performed. No major complications during hospital stay, with a two-day hospitalization period, all tolerating blended diet upon discharge. Improvement in symptoms and quality of life was observed in all cases, with an associated mean weight gain of 9.2 kilograms.

Six-month manometry showed hypotonia/normotonia of the lower esophageal sphincter in all cases examined. Endoscopy in 11 patients revealed grade A esophagitis in 4 of them, controlled heartburn with proton pump inhibitors (PPIs) in 100% of patients.

POEM as a safe and effective treatment in expert hands. Manageable number of complications and procedure duration. Gastroesophageal reflux as the most common symptom, without serious consequences and controlled under PPI therapy.

Keywords: achalasia, POEM, endoscopy.