title: Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia.
abstract: BACKGROUND
  Pneumatic dilation and laparoscopic Heller myotomy improve parameters of esophageal function such as lower esophageal sphincter (LES) pressure, esophageal emptying, and esophagogastric junction (EGJ) distensibility.
  
  
  OBJECTIVE
  To evaluate the effect of peroral endoscopic myotomy (POEM) on esophagogastric function.
  
  
  METHODS
  Prospective trial.
  
  
  METHODS
  Endoscopy department at a university hospital.
  
  
  METHODS
  All consecutive patients aged >17 years with achalasia and an Eckardt score of ≥3.
  
  
  METHODS
  Before and 3 months after POEM, 10 consecutive patients underwent esophageal manometry, timed barium esophagograms, and EndoFLIP as well as an EGD.
  
  
  METHODS
  Eckardt symptom score, LES resting pressure, centimeters of barium stasis, EGJ distensibility, and reflux esophagitis.
  
  
  RESULTS
  Compared with scores before POEM, patient symptom scores were significantly reduced (1, interquartile range [IQR 0-1] vs 8 [IQR 4-8]; P = .005). LES pressure decreased significantly (6.0 mm Hg [IQR 2.6-7.4] vs 19.0 mm Hg [IQR 13.0-28.0]; P = .008). Esophageal emptying increased significantly, and a 5-minute barium column measured 2.3 cm (IQR 0-3.2 cm) versus 10.1 cm (IQR 5.7-10.8 cm; P = .005). EGJ distensibility increased significantly (6.7 mm(2)/mm Hg [IQR 3.8-16.6] vs 1.0 mm(2)/mm Hg [IQR 0.4-2.3]; P = .02) at 50 mL. In 6 of 10 patients, reflux esophagitis was seen. Of these patients, 3 reported reflux symptoms.
  
  
  CONCLUSIONS
  Small number of patients, short-term follow-up.
  
  
  CONCLUSIONS
  POEM improves esophagogastric function and suggests favorable long-term results based on Eckardt score, esophageal manometry, esophageal emptying, and EGJ distensibility. Long-term follow-up of larger series will determine whether the high rate of reflux esophagitis affects the clinical application of POEM.
authors: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Tessa
authors: T
authors: Verlaan
authors: Wout O
authors: WO
authors: Rohof
authors: Albert J
authors: AJ
authors: Bredenoord
authors: Susanne
authors: S
authors: Eberl
authors: Thomas
authors: T
authors: Rösch
authors: Paul
authors: P
authors: Fockens
mesh_terms: D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome