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Per-Oral Endoscopic Myotomy for the treatment of non-achalasia esophageal dysmotility disorders: Experience from a single high-volume center
Timothy J. Morley1, Matthew F. Mikulski1, Matthew Rade1, Jean Chalhoub2, David Desilets2, John Romanelli1
1Surgery, University of Massachusetts Medical School - Baystate Medical Center, Springfield, Massachusetts, United States, 2Gastroenterology, University of Massachusetts Medical School - Baystate Medical Center, Springfield, Massachusetts, United States

1. OBJECTIVES:
Present our experience treating non-achalasia esophageal dysmotility disorders with Per-Oral Endoscopic Myotomy (POEM), demonstrating safety and efficacy.

2. DESIGN:
Case series

3. SETTING:
Tertiary referral academic medical center

4. PATIENTS:
Consecutive series who underwent POEM for non-achalasia esophageal dysmotility disorders.

5. INTERVENTION:
POEM was performed by a surgeon-endoscopist pair under general anesthesia. A gastroscope was used to identify the gastroesophageal junction (EGJ), create a submucosal tunnel and perform myotomy proximal to the EGJ and extending at least 2cm distal to the EGJ.

6. MAIN OUTCOME MEASURES:
Primary: Symptom resolution measured by Eckardt Score
Secondary: Indication, myotomy length, conversion to laparoscopic procedure, operative time, length of stay (LOS)

7. RESULTS:
Included 17 adults, mean age 62.5 10.9 years. One case of nutcracker esophagus was aborted and excluded from statistical analysis. Of the remaining 16 cases, 9 were performed for EGJ outflow obstruction, 6 for jackhammer esophagus, and 1 for distal esophageal spasm. Average BMI was 27.9 6. Average preoperative Eckardt score was 7 2. Average myotomy length was 10.4 1.7cm. Pneumoperitoneum was encountered twice. LOS was 1.3 1.0 days, and average operative time was 79.9 25.6 minutes. Two additional cases failed but were included in analysis. Postoperative Eckart score was 1.33 2.2. There were no conversions to open surgery, or patient deaths.

8. CONCLUSIONS:
POEM is a safe, minimally invasive procedure and can be an effective treatment for a broad scope of esophageal dysmotility disorders in experienced hands.


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