title: Per-oral endoscopic myotomy for achalasia. Are results comparable to laparoscopic Heller myotomy?
abstract: OBJECTIVE
  Per-oral endoscopic myotomy (POEM) has recently been introduced as a minimal invasive alternative to conventional treatment for achalasia. This study aimed to clarify the feasibility and the short-term clinical efficacy of POEM as compared to laparoscopic Heller myotomy (LHM).
  
  
  METHODS
  Treatment outcomes were prospectively recorded and compared between the procedures in a nonrandomized fashion. Reduction rate (RR) in timed barium esophagogram (TBE) was calculated at 1, 2 and 5 min after barium ingestion as: RR = 1- postoperative barium height/preoperative barium height. Risk factors for treatment failure defined as the proportion of patients with RR <0.5 (1 min) and gastroesophageal reflux (GER) after POEM were analyzed.
  
  
  RESULTS
  Forty-two consecutive patients who underwent POEM were compared to 41 patients who had a LHM during the immediate time period prior to the introduction of POEM. Ninety percent of the cases reported complete symptom relief after POEM. The percentage of esophageal emptying and RR in TBE improved dramatically by both procedures without significant difference. A longer operation time (odds ratio [OR] 32.80, 95%CI 2.99-359.82, p = 0.004) and younger age (OR 26.81, 95%CI 2.09-344.03, p = 0.012) were the independent predictors of treatment failure after POEM. GER was observed in seven patients where previous dilatation (OR 8.59, 95%CI 1.16-63.45, p = 0.035) and higher body mass index (OR 8.69, 95%CI 1.13-66.63, p = 0.037) were the independent predictors for symptomatic GER after POEM.
  
  
  CONCLUSIONS
  POEM seems to be a safe and effective treatment option for achalasia in the short-term perspective; an effect well comparable to LHM.
authors.affiliation: Gastrocentrum, Karolinska University Hospital and CLINTEC, Karolinska Institutet , Stockholm , Sweden.
authors.forename: Koshi
authors.initials: K
authors.lastname: Kumagai
authors.forename: Jon A
authors.initials: JA
authors.lastname: Tsai
authors.forename: Anders
authors.initials: A
authors.lastname: Thorell
authors.forename: Lars
authors.initials: L
authors.lastname: Lundell
authors.forename: Bengt
authors.initials: B
authors.lastname: Håkanson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003680:Deglutition Disorders; D004106:Dilatation; D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D061646:Operative Time; D016032:Randomized Controlled Trials as Topic; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
keywords: Heller myotomy; POEM; achalasia; dysphagia; gastroesophageal reflux; timed barium esophagogram; treatment failure