title: Early clinical experience with the POEM procedure for achalasia.
abstract: BACKGROUND
  Per oral endoscopic myotomy (POEM) is a viable alternative to standard Heller myotomy for surgical treatment of achalasia. Outcomes from the United States, Europe and Asia have been reported. We sought to report data after the initiation of POEM in a Canadian centre.
  
  
  METHODS
  We enrolled patients with achalasia in a research ethics board-approved pilot study. Surgeons learned the POEM procedure in a systematic manner that included visiting experts in POEM, practice in an animal laboratory and mentoring from POEM experts. Preoperative evaluation included manometry, 24-hour pH, barium swallow, endoscopy and Eckhardt Symptom Score. All patients underwent gastrograffin swallow on postoperative day 1. Patients were re-evaluated using the Eckhardt score on postoperative day 14.
  
  
  RESULTS
  Ten patients underwent POEM. Seven patients had previous endoscopic treatments: 6 had balloon dilatation and 1 had botulinum toxin injection. Mean preoperative Eckhardt score was 8.1 ± 2.4. Mean preoperative lower esophageal sphincter resting and residual pressure was 32.3 ± 9.2 and 20.8 ± 5.3, respectively. Mean duration of surgery was 141.3 ± 43.7 minutes. Mean length of hospital stay was 1 day. No major perioperative complications occurred. On postoperative day 14, the mean Eckhardt score was 1 ± 1.2.
  
  
  CONCLUSIONS
  Our approach to POEM introduction was systematic and deliberate. The procedure is safe, feasible and has good perioperative outcomes. Our early results are consistent with current literature.
authors.affiliation: All authors are from the Department of Surgery, McMaster University, Hamilton, Ont.
authors.forename: Dennis
authors.initials: D
authors.lastname: Hong
authors.affiliation: All authors are from the Department of Surgery, McMaster University, Hamilton, Ont.
authors.forename: Radu
authors.initials: R
authors.lastname: Pescarus
authors.affiliation: All authors are from the Department of Surgery, McMaster University, Hamilton, Ont.
authors.forename: Rana
authors.initials: R
authors.lastname: Khan
authors.affiliation: All authors are from the Department of Surgery, McMaster University, Hamilton, Ont.
authors.forename: Luciano
authors.initials: L
authors.lastname: Ambrosini
authors.affiliation: All authors are from the Department of Surgery, McMaster University, Hamilton, Ont.
authors.forename: Mehran
authors.initials: M
authors.lastname: Anvari
authors.affiliation: All authors are from the Department of Surgery, McMaster University, Hamilton, Ont.
authors.forename: Margherita
authors.initials: M
authors.lastname: Cadeddu
mesh_terms: D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008365:Manometry; D010865:Pilot Projects; D016896:Treatment Outcome