title: Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study.
abstract: OBJECTIVE
  Endoscopic balloon dilatation and laparoscopic myotomy are established treatments for achalasia. Recently, a new endoscopic technique for complete myotomy was described. Herein, we report the results of the first prospective trial of peroral endoscopic myotomy (POEM) in Europe.
  
  
  METHODS
  POEM was performed under general anesthesia in 16 patients (male:female (12:4), mean age 45 years, range 26-76). The primary outcome was symptom relief at 3 months, defined as an Eckhard score ≤3. Secondary outcomes were procedure-related adverse events, lower esophageal sphincter (LES) pressure on manometry, reflux symptoms, and medication use before and after POEM.
  
  
  RESULTS
  A 3-month follow-up was completed for all patients. Treatment success (Eckhard score ≤3) was achieved in 94% of cases (mean score pre- vs. post-treatment (8.8 vs. 1.4); P<0.001). Mean LES pressure was 27.2 mm Hg pre-treatment and 11.8 mm Hg post-treatment (P<0.001). No patient developed symptoms of gastro-esophageal reflux after treatment, but one patient was found to have an erosive lesion (LA grade A) on follow-up esophagogastroduodenoscopy. No patient required medication with proton pump inhibitors or antacids after POEM.
  
  
  CONCLUSIONS
  POEM is a promising new treatment for achalasia resulting in short-term symptom relief in >90% of cases. Studies evaluating long-term efficacy and comparing POEM with established treatments have been initiated.
authors: Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. renteln@gmx.net
authors: Daniel
authors: D
authors: von Renteln
authors: Haruhiro
authors: H
authors: Inoue
authors: Hiromi
authors: H
authors: Minami
authors: Yuki Birgit
authors: YB
authors: Werner
authors: Andrea
authors: A
authors: Pace
authors: Jan Felix
authors: JF
authors: Kersten
authors: Chressen Catharina
authors: CC
authors: Much
authors: Guido
authors: G
authors: Schachschal
authors: Oliver
authors: O
authors: Mann
authors: Jutta
authors: J
authors: Keller
authors: Karl-Hermann
authors: KH
authors: Fuchs
authors: Thomas
authors: T
authors: Rösch
mesh_terms: D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000601:surgery*; D004945:Esophagoscopy; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008365:Manometry; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome