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Per-Oral Endoscopic Myotomy (POEM) for Achalasia: Early Experience
*Rebecca Kowalski, John R Romanelli, *David J Desilets, *David B Earle
Baystate Medical Center, Tufts University School of Medicine, Springfield, MA

Objective: Per-Oral Endoscopic Myotomy (POEM) is a new surgical treatment for achalasia, first reported in Japan in 2010. The operation involves endoscopic creation of a submucosal esophageal tunnel, followed by division of the circular muscle fibers. No incisions are created, leaving the hope for faster recovery. This report reflects our early experience.
Design: Consecutive case series. Mean follow-up is 12.5 months.
Setting: Academic Community Medical Center.
Patients: 12 patients (7 females, 5 males), who had manometrically-proven achalasia. Their mean age was 53 (range 29 - 73). None of them had prior surgical treatment. All subjects who were offered POEM accepted. Inclusion criteria were: manometrically-proven achalasia; no prior surgical treatment; age between 18-75; medical status stable to undergo surgery.
Interventions: POEM procedure.
Main Outcome Measures: Relief of symptoms. For two most recent patients, preoperative and postoperative Eckhardt scores were utilized. Complications and need for further invention (indicating treatment failure or partial failure).
Results: 12 patients underwent POEM, 1 patient had to be converted to laparoscopic Heller myotomy (the criterion standard). Of the 11 completed cases, 9 had complete symptom relief. Two patients had to undergo subsequent balloon dilatation and are considered treatment failures. 6 of 11 patients developed pneumoperitoneum requiring Veress needle decompression. There were no other complications. Two patients had preoperative Eckardt scores measured (mean: 8/12); their scores were 0 at their initial postoperative visit, indicating complete resolution of symptoms.
Conclusions: POEM is a safe and effective surgical treatment for achalasia. More experience is needed before recommending widespread adoption of the procedure.

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