The Performance of Peroral Endoscopic Myotomy in Sigmoid-Type Achalasia
Issued Date
2024-01-01
Resource Type
eISSN
22288082
Scopus ID
2-s2.0-85204010145
Journal Title
Siriraj Medical Journal
Volume
76
Issue
9
Start Page
611
End Page
619
Rights Holder(s)
SCOPUS
Bibliographic Citation
Siriraj Medical Journal Vol.76 No.9 (2024) , 611-619
Suggested Citation
Phalanusitthepha C., Maneesoi S., Watthanatham J., Suwatthanarak T., Chinswangwatanakul V., Akaraviputh T., Methasate A., Maneerattanaporn M., Leelakusolvong S. The Performance of Peroral Endoscopic Myotomy in Sigmoid-Type Achalasia. Siriraj Medical Journal Vol.76 No.9 (2024) , 611-619. 619. doi:10.33192/smj.v76i9.269112 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/101326
Title
The Performance of Peroral Endoscopic Myotomy in Sigmoid-Type Achalasia
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Corresponding Author(s)
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Abstract
Objective: Sigmoid-type achalasia represents an advanced stage of achalasia characterized by significant dilation and tortuosity of the esophageal lumen. Considering the demonstrated efficacy of peroral endoscopic myotomy (POEM) in treating early-stage achalasia, this procedure may offer an alternative therapeutic approach for sigmoid-type achalasia. This study aimed to assess POEM’s feasibility and short-term efficacy in patients with sigmoid-type achalasia. Materials and Methods: We enrolled 16 consecutive patients with sigmoid-type achalasia (eight with type 1 and eight with type 2). The anticipated outcomes were symptom relief during the 12-month follow-up period (evaluated through a reduction in Eckardt symptom scores), an acceptable incidence of procedure-related adverse events, and a decrease in esophageal diameter and barium height. Results: POEM was successfully performed in all cases, with a median operative time of 118.50 minutes (range: 52–206 minutes). No serious complications associated with POEM were observed. During the 12-month follow-up period, the median Eckardt symptom score decreased from 6 (2-10) preoperatively to 1 (0-3) (P = 0.008). Complications were mucosal injuries (31.25% of cases), pneumoperitoneum (12.5%), and minor bleeding (6.25%), although no interventions were needed. Conclusion: POEM procedure has exhibited favorable treatment outcomes, showcasing a high clinical success rate in addressing sigmoid-type achalasia. Despite the occurrence of acceptable adverse events, the procedure remains a viable alternative treatment or bridging therapy for sigmoid-type achalasia. Nonetheless, it is crucial to acknowledge that this procedure presents greater challenges in comparison to the treatment of typical achalasia.