title: Efficacy of peroral endoscopic myotomy vs other achalasia treatments in improving esophageal function.
abstract: OBJECTIVE
  To assess and compare the esophageal function after peroral endoscopic myotomy (POEM) vs other conventional treatments in achalasia.
  
  
  METHODS
  Chart review of all achalasia patients who underwent POEM, laparoscopic Heller myotomy (LHM) or pneumatic dilation (PD) at our institution between January 2012 and March 2015 was performed. Patient demographics, type of achalasia, prior treatments, pre- and post-treatment timed barium swallow (TBE) and high-resolution esophageal manometry (HREM) findings were compared between the three treatment groups. Patients who had both pre- and 2 mo post-treatment TBE or HREM were included in the final analysis. TBE parameters compared were barium column height, width and volume of barium remaining at 1 and 5 min. HREM parameters compared were basal lower esophageal sphincter (LES) pressures and LES-integrated relaxation pressures (IRP). Data are presented as mean ± SD, median [25(th), 75(th) percentiles] or frequency (percent). Analysis of variance, Kruskal-Wallis test, Pearsons χ(2) test and Fishers Exact tests were used for analysis.
  
  
  RESULTS
  A total of 200 achalasia patients were included of which 36 underwent POEM, 22 underwent PD and 142 underwent LHM. POEM patients were older (55.4 ± 16.8 years vs 46.5 ± 15.7 years, P = 0.013) and had higher BMI than LHM (29.1 ± 5.9 kg/m(2) vs 26 ± 5.1 kg/m(2), P = 0.012). More number of patients in POEM and PD groups had undergone prior treatments compared to LHM group (72.2% vs 68.2% vs 44.3% respectively, P = 0.003). At 2 mo post-treatment, all TBE parameters including barium column height, width and volume remaining at 1 and 5 min improved significantly in all three treatment groups (P = 0.01 to P < 0.001) except the column height at 1 min in PD group (P = 0.11) . At 2 mo post-treatment, there was significant improvement in basal LES pressure and LES-IRP in both LHM (40.5 mmHg vs 14.5 mmHg and 24 mmHg vs 7.1 mmHg respectively, P < 0.001) and POEM groups (38.7 mmHg vs 11.4 mmHg and 23.6 mmHg vs 6.6 mmHg respectively, P < 0.001). However, when the efficacy of three treatments were compared to each other in terms of improvement in TBE or HREM parameters at 2 mo, there was no significant difference (P > 0.05).
  
  
  CONCLUSIONS
  POEM, PD and LHM were all effective in improving esophageal function in achalasia at short-term. There was no difference in efficacy between the three treatments.
authors.affiliation: Madhusudhan R Sanaka, Umar Hayat, Prashanthi N Thota, Ramprasad Jegadeesan, Monica Ray, Scott L Gabbard, Neha Wadhwa, Rocio Lopez, Department of Gastroenterology, Q3 Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
authors.affiliation: Madhusudhan R Sanaka, Umar Hayat, Prashanthi N Thota, Ramprasad Jegadeesan, Monica Ray, Scott L Gabbard, Neha Wadhwa, Rocio Lopez, Department of Gastroenterology, Q3 Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Umar
authors.initials: U
authors.lastname: Hayat
authors.affiliation: Madhusudhan R Sanaka, Umar Hayat, Prashanthi N Thota, Ramprasad Jegadeesan, Monica Ray, Scott L Gabbard, Neha Wadhwa, Rocio Lopez, Department of Gastroenterology, Q3 Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Prashanthi N
authors.initials: PN
authors.lastname: Thota
authors.affiliation: Madhusudhan R Sanaka, Umar Hayat, Prashanthi N Thota, Ramprasad Jegadeesan, Monica Ray, Scott L Gabbard, Neha Wadhwa, Rocio Lopez, Department of Gastroenterology, Q3 Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Ramprasad
authors.initials: R
authors.lastname: Jegadeesan
authors.affiliation: Madhusudhan R Sanaka, Umar Hayat, Prashanthi N Thota, Ramprasad Jegadeesan, Monica Ray, Scott L Gabbard, Neha Wadhwa, Rocio Lopez, Department of Gastroenterology, Q3 Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Monica
authors.initials: M
authors.lastname: Ray
authors.affiliation: Madhusudhan R Sanaka, Umar Hayat, Prashanthi N Thota, Ramprasad Jegadeesan, Monica Ray, Scott L Gabbard, Neha Wadhwa, Rocio Lopez, Department of Gastroenterology, Q3 Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Gabbard
authors.affiliation: Madhusudhan R Sanaka, Umar Hayat, Prashanthi N Thota, Ramprasad Jegadeesan, Monica Ray, Scott L Gabbard, Neha Wadhwa, Rocio Lopez, Department of Gastroenterology, Q3 Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Neha
authors.initials: N
authors.lastname: Wadhwa
authors.affiliation: Madhusudhan R Sanaka, Umar Hayat, Prashanthi N Thota, Ramprasad Jegadeesan, Monica Ray, Scott L Gabbard, Neha Wadhwa, Rocio Lopez, Department of Gastroenterology, Q3 Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Madhusudhan R Sanaka, Umar Hayat, Prashanthi N Thota, Ramprasad Jegadeesan, Monica Ray, Scott L Gabbard, Neha Wadhwa, Rocio Lopez, Department of Gastroenterology, Q3 Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Baker
authors.affiliation: Madhusudhan R Sanaka, Umar Hayat, Prashanthi N Thota, Ramprasad Jegadeesan, Monica Ray, Scott L Gabbard, Neha Wadhwa, Rocio Lopez, Department of Gastroenterology, Q3 Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Sudish
authors.initials: S
authors.lastname: Murthy
authors.affiliation: Madhusudhan R Sanaka, Umar Hayat, Prashanthi N Thota, Ramprasad Jegadeesan, Monica Ray, Scott L Gabbard, Neha Wadhwa, Rocio Lopez, Department of Gastroenterology, Q3 Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Siva
authors.initials: S
authors.lastname: Raja
mesh_terms: D000328:Adult; D000368:Aged; D001466:Barium Sulfate / Q000008:administration & dosage; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage; D003679:Deglutition; D004106:Dilatation; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008365:Manometry; D008875:Middle Aged; D015999:Multivariate Analysis; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects; D009820:Ohio; D011312:Pressure; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate
keywords: Achalasia; Dysphagia; Heller myotomy; Manometry; Peroral endoscopic myotomy; Pneumatic dilation