title: Peroral endoscopic myotomy (POEM) for oesophageal achalasia: preliminary results in humans.
abstract: BACKGROUND
  Peroral endoscopic myotomy has been developed to provide a less invasive treatment for oesophageal achalasia compared to surgical cardiomyotomy.
  
  
  OBJECTIVE
  To report our initial experience on feasibility, safety and clinical efficacy of peroral endoscopic myotomy.
  
  
  METHODS
  Eleven patients (eight women, mean age 32, range 24-58) underwent an attempt at peroral endoscopic myotomy under general anaesthesia. After submucosal injection, a mucosal entry into the oesophageal submucosa, and a tunnel extending to the oesophagogastric junction and beyond into the stomach were created (total mean length: 15 ± 1.7 cm). Myotomy of the circular oesophageal and gastric muscle bundles was then achieved under direct vision (total mean length: 10.2 ± 2.8 cm). Haemostatic clips were used to close the mucosal entry. The Eckardt Score and manometry were used to evaluate the results.
  
  
  RESULTS
  Peroral endoscopic myotomy could be completed in 10 out of 11 patients (91%). Mean procedure time was 100.7 min (range 75-140 min). No major complication occurred. Clinical success was achieved in all patients at 1-month follow-up (Eckardt Score 7.1 vs. 1.1, p=0). Lower oesophageal sphincter pressure decreased from 45.1 to 16.9 mm Hg (p=0).
  
  
  CONCLUSIONS
  This initial experience with peroral endoscopic myotomy shows its safety and efficacy in the treatment of achalasia. Further studies are warranted to assess the long-term efficacy and to compare peroral endoscopic myotomy with other treatment modalities.
authors.affiliation: Digestive Endoscopy Unit, Department of Surgery, Catholic University, Rome, Italy. gcostamagna@rm.unicatt.it
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.forename: Michele
authors.initials: M
authors.lastname: Marchese
authors.forename: Pietro
authors.initials: P
authors.lastname: Familiari
authors.forename: Andrea
authors.initials: A
authors.lastname: Tringali
authors.forename: Haruhiro
authors.initials: H
authors.lastname: Inoue
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Perri
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods*; D004931:Esophageal Achalasia / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane; D016896:Treatment Outcome; D055815:Young Adult