Peroral Endoscopic Myotomy (POEM) for the treatment of achalasia in an Egyptian cohort

Abstract

Abstract Background and study aims Peroral endoscopic myotomy (POEM) has been regarded as a novel and minimally invasive therapy for the treatment of achalasia. Data from the Middle East and North Africa (MENA) region and Arabic countries are scarce, and this study represents the first study from this area. The aim of this study was to assess the efficacy and safety of POEM in an Egyptian cohort. Patients and methods This is a prospective study that included 34 Egyptian patients who underwent POEM for achalasia. Results This study included 19 (55.9%) males with a median age of 33.5 years (range: 11–75 years). 16 (47.1%) patients had previous pneumatic balloon dilation, and 1 (2.9%) patient had previous surgical myotomy. The median Eckardt score pre-POEM was 9 (range: 4–12). The median integrated relaxation pressure for 4 s (IRP4s) was 25.6 mmHg (range: 11.5–49.4 mmHg). High-resolution manometry showed that 12 patients had type I achalasia (35.2%), 18 patients had type II achalasia (52.9%), and 4 patients had type III achalasia (11.7%). The median procedure time was 120 min (range: 75–260 min). Technical success was achieved in all patients (100%), and clinical success was achieved in 33/34 patients (97.1%). There was no significant difference in success rates among different types of achalasia (p 0.208). There was a significant reduction in the Eckardt score (P < 0.0001) and IRP4s values pre- and post-POEM (P < 0.0001). There was also a significant increase in the body mass index of the patients (P 0.006) during a median follow-up of 10 months (range: 6–24 months). Conclusions POEM is a safe, effective, and feasible treatment option for achalasia in an Egyptian cohort. POEM is becoming an attractive option and is gaining patient satisfaction.

Keywords

• POEM (peroral endoscopic myotomy)
• Esophageal achalasia
• Third space endoscopy
• NOTES (natural orifice transluminal endoscopic surgery)
• Egypt