title: Two-Person Technique of Peroral Endoscopic Myotomy for Achalasia with an Advanced Endoscopist and a Thoracic Surgeon: Initial Experience.
abstract: Background and Aims. We initiated peroral endoscopic myotomy (POEM) utilizing a two-person technique with combination of an advanced endoscopist and a thoracic surgeon with complementary skills. Our aim was to determine the feasibility and outcomes in initial 20 patients. Methods. In this observational study, main outcomes measured were therapeutic success in relieving symptoms (Eckardt score < 3), decrease in lower esophageal sphincter (LES) pressures, improvement in emptying on timed barium esophagogram (TBE), and complications. Results. POEM was successful in all 20 patients with a mean operative time of 140.1 + 32.9 minutes. Eckardt symptom scores decreased significantly at two-month follow-up (6.4 + 2.9 versus 0.25 + 0.45, p < 0.001). Both basal and residual LES pressures decreased significantly (28.2 + 14.1 mmHg versus 12.8 + 6.3 and 22.4 + 11.3 versus 6.3 + 3.4 mmHg, p = 0.025 and <0.001, resp.). Barium column height at 5 minutes on TBE reduced from 6.8 + 4.9 cm to 2.3 + 2.9 cm (p = 0.05). Two patients (10%) had mucosal perforations and one had delayed bleeding (5%). Conclusions. Two-person technique of POEM with combination of an advanced endoscopist and a thoracic surgeon is highly successful with low risk of complications.
authors.affiliation: Department of Gastroenterology, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Madhusudhan R
authors.identifier: 0000-0003-2506-8602
authors.initials: MR
authors.lastname: Sanaka
authors.affiliation: Department of Gastroenterology, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Ramprasad
authors.initials: R
authors.lastname: Jegadeesan
authors.affiliation: Department of Gastroenterology, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Prashanthi N
authors.identifier: 0000-0001-7179-4774
authors.initials: PN
authors.lastname: Thota
authors.affiliation: Department of Gastroenterology, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.affiliation: Department of Gastroenterology, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Department of Thoracic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Sudish C
authors.initials: SC
authors.lastname: Murthy
authors.affiliation: Department of Thoracic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Siva
authors.initials: S
authors.lastname: Raja
mesh_terms: D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005762:Gastroenterology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D010348:Patient Care Team; D013043:Specialties, Surgical; D013903:Thoracic Surgery; D016896:Treatment Outcome