Peroral endoscopic myotomy in achalasia (one centre experience of 150 operations)

Objective. To evaluate the perioperative period and results of peroral endoscopic myotomy (POEM) in patients with achalasia.

Material and methods. During the period 2017–2023, POEM was performed in 150 patients aged 15 to 80 years (mean age 53 ± 15,4 years) (94 women, 56 men). The duration of the disease ranged from 6 months to 40 years (mean value 5,8 ± 6,67 years). The average dysphagia value according to the Eckadt scale before surgery was 11.12±0.75.

Results. Technical difficulties with tunnel formation due to the presence of fibrosis of varying severity were noted in 24 (16.1 %) patients. The presence of fibrosis resulted in a slight increase in the duration of the intervention at the tunnel formation stage 85.0 (80.0; 120.0) minutes versus 95 (80.0; 120.0) (p=0.87554). Adverse events during the procedure were observed in 5 (3.33 %) patients: no differences were noted between patients with stages II–III and IV of the disease (3 versus 2) (p=0.22). No differences were found in the frequency of complications between patients with or without fibrosis in the submucosal layer (p=0.1922). Oral food and fluid intake were restored in all patients. The Eckadt scale score ranged from 0 to 4 (mean 1.48±0.98). There was no statistically significant difference in the frequency of esophagitis in patients with stages II–III of the disease and stage IV (26 versus 5) (p=0.49).

Conclusion. POEM in patients with esophageal achalasia is an effective intervention, regardless of the stage of the disease with a low frequency of intraand postoperative complications. Previous treatment is not a predictor of the occurrence of fibrosis in the submucosal layer, does not affect the frequency of intraoperative complications and does not significantly increase the duration of the intervention. The stage of the disease does not affect the frequency of intraoperative complications and erosive esophagitis.

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