title: Peroral endoscopic myotomy for achalasia cardia: Treatment analysis and follow up of over 200 consecutive patients at a single center.
abstract: OBJECTIVE
  Peroral endoscopic myotomy (POEM) is a recently introduced technique for the treatment of achalasia cardia (AC). Data regarding safety and efficacy are still emerging. We report our experience of POEM emphasizing its safety, efficacy and follow-up data.
  
  
  METHODS
  Patients with AC (220; mean age 39 years, range 9-74 years) underwent POEM from January 2013 to August 2014 for AC. Retrospective analysis of prospectively collected data was done. POEM was carried out by the standard technique of mucosal incision, submucosal tunneling, and myotomy of the esophageal and gastric muscle bundles followed by closure of the mucosal incision by hemoclips. Eckardt score, high-resolution manometry (HRM) and timed barium esophagogram (TBE) were used to evaluate the results. Post-procedure patients were followed up.
  
  
  RESULTS
  Technical success rate of POEM was 96%. At 1 year, clinical success rate was 92%. Mean Eckardt score was 7.2 ± 1.55 prior to POEM and 1.18 ± 0.74 after POEM (P = 0.001). There was significant improvement of esophageal emptying on TBE (38.4 ± 14.0 % vs 71.5 ± 16.1 % (P = 0.001). Pre-procedure and post-procedure mean lower esophageal sphincter pressure was 37.5 ± 14.5 mmHg and 15.2 ± 6.3 mmHg, respectively. (P = 0.001) Erosive esophagitis was seen in 16% of patients who underwent POEM. There were no major adverse events.
  
  
  CONCLUSIONS
  Study demonstrates excellent safety profile of POEM with significant relief of symptoms, reduced pressure at HRM and improved emptying at TBE. Further prospective studies are required to compare with other treatment modalities.
authors.affiliation: Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: Mohan
authors.initials: M
authors.lastname: Ramchandani
authors.affiliation: Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: D
authors.initials: D
authors.lastname: Nageshwar Reddy
authors.affiliation: Anesthesiology Department, Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: Santosh
authors.initials: S
authors.lastname: Darisetty
authors.affiliation: Anesthesiology Department, Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: Rama
authors.initials: R
authors.lastname: Kotla
authors.affiliation: Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: Radhika
authors.initials: R
authors.lastname: Chavan
authors.affiliation: Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kalpala
authors.affiliation: Digestive Endoscopy Unit, 'A. Gemelli' Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Galasso
authors.affiliation: Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Lakhtakia
authors.affiliation: Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: G V
authors.initials: GV
authors.lastname: Rao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Achalasia cardia; Minimally invasive surgery; POEM; Per oral endoscopic myotomy; natural orifice transluminal endoscopic surgery