title: International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video).
abstract: BACKGROUND
  Limited data exist on the use of peroral endoscopic myotomy (POEM) for therapy of spastic esophageal disorders (SEDs).
  
  
  OBJECTIVE
  To study the efficacy and safety of POEM for the treatment of patients with diffuse esophageal spasm, jackhammer esophagus, or type III (spastic) achalasia.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  International, multicenter, academic institutions.
  
  
  METHODS
  All patients who underwent POEM for treatment of SEDs refractory to medical therapy at 11 centers were included.
  
  
  METHODS
  POEM.
  
  
  METHODS
  Eckardt score and adverse events.
  
  
  RESULTS
  A total of 73 patients underwent POEM for treatment of SEDs (diffuse esophageal spasm 9, jackhammer esophagus 10, spastic achalasia 54). POEM was successfully completed in all patients, with a mean procedural time of 118 minutes. The mean length of the submucosal tunnel was 19 cm, and the mean myotomy length was 16 cm. A total of 8 adverse events (11%) occurred, with 5 rated as mild, 3 moderate, and 0 severe. The mean length of hospital stay was 3.4 days. There was a significant decrease in Eckardt scores after POEM (6.71 vs 1.13; P = .0001). Overall, clinical response was observed in 93% of patients during a mean follow-up of 234 days. Chest pain significantly improved in 87% of patients who reported chest pain before POEM. Repeat manometry after POEM was available in 44 patients and showed resolution of initial manometric abnormalities in all cases.
  
  
  CONCLUSIONS
  Retrospective design and selection bias.
  
  
  CONCLUSIONS
  POEM offers a logical therapeutic modality for patients with SEDs refractory to medical therapy. Results from this international study suggest POEM as an effective and safe platform for these patients.
authors: Johns Hopkins Medical Institute, Baltimore, Maryland, USA.
authors: Mouen A
authors: MA
authors: Khashab
authors: Johns Hopkins Medical Institute, Baltimore, Maryland, USA.
authors: Ahmed A
authors: AA
authors: Messallam
authors: Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors: Manabu
authors: M
authors: Onimaru
authors: Northwestern University, Chicago, Illinois, USA.
authors: Ezra N
authors: EN
authors: Teitelbaum
authors: North Shore University Health System, Evanston, Illinois, USA.
authors: Michael B
authors: MB
authors: Ujiki
authors: North Shore University Health System, Evanston, Illinois, USA.
authors: Matthew E
authors: ME
authors: Gitelis
authors: Winthrop University Hospital, Mineola, New York, USA.
authors: Rani J
authors: RJ
authors: Modayil
authors: Northwestern University, Chicago, Illinois, USA.
authors: Eric S
authors: ES
authors: Hungness
authors: Winthrop University Hospital, Mineola, New York, USA.
authors: Stavros N
authors: SN
authors: Stavropoulos
authors: Johns Hopkins Medical Institute, Baltimore, Maryland, USA.
authors: Mohamad H
authors: MH
authors: El Zein
authors: Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors: Hironari
authors: H
authors: Shiwaku
authors: Aarhus University Hospital, Aarhus, Denmark.
authors: Rastislav
authors: R
authors: Kunda
authors: Humanitas Research Hospital, Milano, Italy.
authors: Alessandro
authors: A
authors: Repici
authors: Nagasaki University Hospital, Nagasaki, Japan.
authors: Hitomi
authors: H
authors: Minami
authors: Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors: Philip W
authors: PW
authors: Chiu
authors: University Hospitals Case Medical Center, Cleveland, Ohio, USA.
authors: Jeffrey
authors: J
authors: Ponsky
authors: Johns Hopkins Medical Institute, Baltimore, Maryland, USA.
authors: Vivek
authors: V
authors: Kumbhari
authors: Johns Hopkins Medical Institute, Baltimore, Maryland, USA.
authors: Payal
authors: P
authors: Saxena
authors: Baladota Institute of Digestive Sciences, Mumbai, India.
authors: Amit P
authors: AP
authors: Maydeo
authors: Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors: Haruhiro
authors: H
authors: Inoue
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000209:etiology; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D015155:Esophageal Spasm, Diffuse / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy; D004947:Esophagus; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D012189:Retrospective Studies