title: A utility of peroral endoscopic myotomy (POEM) across the spectrum of esophageal motility disorders.
abstract: BACKGROUND
  Peroral endoscopic myotomy (POEM) has been performed as a novel endoscopic procedure to treat achalasia with favorable outcome. The objective of this study was to assess the outcome of POEM in our initial series and to assess the safety and efficacy of POEM in a variety of esophageal motility-related clinical problems.
  
  
  METHODS
  This is a retrospective cross-sectional study involving all patients with esophageal motility disorders defined by the Chicago classification, who had undergone consideration for POEM at our institution. Validated questionnaires such as gastroesophageal reflux disease health-related quality of life (GERD-HRQL), reflux symptom index (RSI) and achalasia disease-specific health-related quality of life were obtained pre- and postoperatively.
  
  
  RESULTS
  From January 2013 to October 2014, a total of 35 POEMs (achalasia n = 25, non-achalasia n = 10) were performed on 33 patients (female n = 20, male n = 13, mean age 56.9 years). There was no mortality. The rate of inadvertent mucosotomy was 17.1%. The rate of complications requiring interventions was 5.7%. During a mean follow-up period of 7 months (range 0.5-17), 92% of patients with achalasia and 75% of those with non-achalasia motility disorders had a symptomatic improvement in dysphagia. Chest pain was completely resolved in all patients with achalasia (8/8) and 80% of patients with non-achalasia (4/5). The GERD-HRQL, RSI and dysphagia scores significantly improved after POEM in patients with achalasia. There was a significant improvement in GERD-HRQL and RSI scores, and a trend toward lower dysphagia score in patients with non-achalasia.
  
  
  CONCLUSIONS
  The outcome of POEM to treat achalasia and non-achalasia motility disorders is consistent with previous studies. Potential benefit of POEM includes not only its flexibility to adjust the length and location of myotomy but also the ability to extend myotomy proximally without thoracoscopy or thoracotomy. POEM can be combined with laparoscopic procedures and used as "salvage" for localized esophageal dysmotility.
authors.affiliation: Esophageal and Lung Institute, Allegheny Health Network, 4800 Friendship Avenue, Suite 4600, Pittsburgh, PA, 15224, USA. thoppo@wpahs.org.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Hoppo
authors.affiliation: Esophageal and Lung Institute, Allegheny Health Network, 4800 Friendship Avenue, Suite 4600, Pittsburgh, PA, 15224, USA.
authors.forename: Shyam J
authors.initials: SJ
authors.lastname: Thakkar
authors.affiliation: Esophageal and Lung Institute, Allegheny Health Network, 4800 Friendship Avenue, Suite 4600, Pittsburgh, PA, 15224, USA.
authors.forename: Lana Y
authors.initials: LY
authors.lastname: Schumacher
authors.affiliation: Esophageal and Lung Institute, Allegheny Health Network, 4800 Friendship Avenue, Suite 4600, Pittsburgh, PA, 15224, USA.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Komatsu
authors.affiliation: Esophageal and Lung Institute, Allegheny Health Network, 4800 Friendship Avenue, Suite 4600, Pittsburgh, PA, 15224, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Choe
authors.affiliation: Esophageal and Lung Institute, Allegheny Health Network, 4800 Friendship Avenue, Suite 4600, Pittsburgh, PA, 15224, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Shetty
authors.affiliation: Esophageal and Lung Institute, Allegheny Health Network, 4800 Friendship Avenue, Suite 4600, Pittsburgh, PA, 15224, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Bloomer
authors.affiliation: Esophageal and Lung Institute, Allegheny Health Network, 4800 Friendship Avenue, Suite 4600, Pittsburgh, PA, 15224, USA.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Lloyd
authors.affiliation: Esophageal and Lung Institute, Allegheny Health Network, 4800 Friendship Avenue, Suite 4600, Pittsburgh, PA, 15224, USA.
authors.forename: Ali H
authors.initials: AH
authors.lastname: Zaidi
authors.affiliation: Esophageal and Lung Institute, Allegheny Health Network, 4800 Friendship Avenue, Suite 4600, Pittsburgh, PA, 15224, USA.
authors.forename: Mathew A
authors.initials: MA
authors.lastname: VanDeusen
authors.affiliation: Esophageal and Lung Institute, Allegheny Health Network, 4800 Friendship Avenue, Suite 4600, Pittsburgh, PA, 15224, USA.
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
authors.affiliation: Esophageal and Lung Institute, Allegheny Health Network, 4800 Friendship Avenue, Suite 4600, Pittsburgh, PA, 15224, USA.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Kulkarni
authors.affiliation: Esophageal and Lung Institute, Allegheny Health Network, 4800 Friendship Avenue, Suite 4600, Pittsburgh, PA, 15224, USA. bjobe1@wpahs.org.
authors.forename: Blair A
authors.initials: BA
authors.lastname: Jobe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004931:Esophageal Achalasia / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery; D012189:Retrospective Studies; D055815:Young Adult
keywords: Achalasia; Chest pain; Dysphagia; Non-achalasia esophageal motility disorders; POEM; Questionnaires
references.citation: Surg Endosc. 2005 Mar;19(3):345-51
references.pmid: 15645326
references.citation: J Gastrointest Surg. 2015 Jan;19(1):161-70; discussion 170
references.pmid: 25183406
references.citation: Ann Surg. 2012 Oct;256(4):659-67
references.pmid: 22982946
references.citation: J Voice. 2002 Jun;16(2):274-7
references.pmid: 12150380
references.citation: Am J Surg. 2005 Dec;190(6):874-8
references.pmid: 16307937
references.citation: Arch Surg. 2005 Sep;140(9):827-33; discussion 833-4
references.pmid: 16172290
references.citation: Gastroenterology. 1996 Sep;111(3):648-54
references.pmid: 8780569
references.citation: Endoscopy. 2010 Apr;42(4):265-71
references.pmid: 20354937
references.citation: Gastrointest Endosc. 2014 Jul;80(1):1-15
references.pmid: 24950639
references.citation: J Clin Gastroenterol. 2008 May-Jun;42(5):627-35
references.pmid: 18364587
references.citation: Ann Surg. 2009 Jan;249(1):45-57
references.pmid: 19106675
references.citation: Am J Gastroenterol. 2005 Aug;100(8):1668-76
references.pmid: 16144120
references.citation: N Engl J Med. 2011 May 12;364(19):1807-16
references.pmid: 21561346
references.citation: Surg Endosc. 2013 Sep;27(9):3322-38
references.pmid: 23549760
references.citation: Gastroenterology. 2010 Aug;139(2):369-74
references.pmid: 20600038
references.citation: Am J Surg Pathol. 1994 Apr;18(4):327-37
references.pmid: 8141427
references.citation: Ann Surg. 2004 Sep;240(3):405-12; discussion 412-5
references.pmid: 15319712
references.citation: Thorac Surg Clin. 2011 Nov;21(4):519-25
references.pmid: 22040634
references.citation: Gastrointest Endosc. 2013 May;77(5):719-25
references.pmid: 23394838
references.citation: Surg Endosc. 2012 Jan;26(1):18-26
references.pmid: 21789646
references.citation: Dig Dis. 1997;15 Suppl 1:1-27
references.pmid: 9177942
references.citation: J Gastrointest Surg. 2006 Dec;10(10):1400-8
references.pmid: 17175461
references.citation: Endoscopy. 2007 Sep;39(9):761-4
references.pmid: 17703382
references.citation: Am J Gastroenterol. 2012 Mar;107(3):411-7
references.pmid: 22068665
references.citation: Ann Surg. 2014 Jun;259(6):1098-103
references.pmid: 24169175
references.citation: J Gastrointest Surg. 2013 Feb;17(2):228-35
references.pmid: 23054897
references.citation: Dis Esophagus. 2007;20(2):130-4
references.pmid: 17439596
references.citation: Dig Liver Dis. 2012 Oct;44(10):827-32
references.pmid: 22609465