title: Peroral endoscopic myotomy (POEM) for esophageal achalasia.
abstract: BACKGROUND
  Peroral endoscopic myotomy (POEM) was developed by our group to provide a less invasive permanent treatment for esophageal achalasia.
  
  
  METHODS
  POEM was performed in 17 consecutive patients with achalasia (10 men, 7 women; mean age 41.4 years). A long submucosal tunnel was created (mean length 12.4 cm), followed by endoscopic myotomy of circular muscle bundles of a mean total length of 8.1 cm (6.1 cm in distal esophagus and 2.0 cm in cardia). Smooth passage of an endoscope through the gastroesophageal junction was confirmed at the end of the procedure.
  
  
  RESULTS
  In all cases POEM significantly reduced the dysphagia symptom score (from mean 10 to 1.3; P = 0.0003) and the resting lower esophageal sphincter (LES) pressure (from mean 52.4 mmHg to 19.9 mmHg; P = 0.0001). No serious complications related to POEM were encountered. During follow-up (mean 5 months), additional treatment or medication was necessary in only one patient (case 17) who developed reflux esophagitis (Los Angeles classification B); this was well controlled with regular intake of protein pump inhibitors (PPIs).
  
  
  CONCLUSIONS
  The short-term outcome of POEM for achalasia was excellent; further studies on long-term efficacy and on comparison of POEM with other interventional therapies are awaited.
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama 224-8503 Japan. haruinoue777@yahoo.co.jp
authors.forename: H
authors.initials: H
authors.lastname: Inoue
authors.forename: H
authors.initials: H
authors.lastname: Minami
authors.forename: Y
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Y
authors.initials: Y
authors.lastname: Sato
authors.forename: M
authors.initials: M
authors.lastname: Kaga
authors.forename: M
authors.initials: M
authors.lastname: Suzuki
authors.forename: H
authors.initials: H
authors.lastname: Satodate
authors.forename: N
authors.initials: N
authors.lastname: Odaka
authors.forename: H
authors.initials: H
authors.lastname: Itoh
authors.forename: S
authors.initials: S
authors.lastname: Kudo
mesh_terms: D000328:Adult; D004931:Esophageal Achalasia / Q000601:surgery*; D004945:Esophagoscopy; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male