Peroral endoscopic myotomy in the treatment of achalasia of the esophagus

Abstract

Background: Peroral endoscopic myotomy (POEM) is a promising new method of radical treatment of neuromuscular diseases of the esophagus, estimated effectiveness of which is comparable to traditional surgery. Aim: To compare the efficacy of peroral endoscopic myotomy and laparoscopic cardiomyotomy in the treatment of neuromuscular diseases of the esophagus. Methods and materials: The study included two groups of patients with neuromuscular diseases of the esophagus. The first group included patients who underwent peroral endoscopic myotomy. The second group included patients who underwent laparoscopic cardiomyotomy. In the period from July 2014 to may 2016 made 39 peroral endoscopic myotomy and 42 laparoscopiс cardiomyotomy. During this period we analyzed the results of 16 patients of the first group and 15 patients of the second group. The average age of patients is 47 years (from 20 to 71 years). The perioperative protocol of examination included endoscopy, X-ray examination of the esophagus, the manometry of the esophagus, evaluation of the severity of dysphagia on a scale Eckardt before and after 3 and 12 months after surgery. Statistical differences were not observed. The average score on a scale Eckardt before surgery was 6.6. Results: Protocol postoperative examination was performed in 31 patients. According to manometry of the esophagus normal values in both groups were registered. The average score on a scale Eckardt – of 0.9 (0-2). In the first group in five observations endoscopic signs of insufficiency of the cardia were detected at endoscopy, clinically pronounced in three patients. In the second group – in two cases, in one – with clinical manifestations. Symptoms relieved by taking inhibitor of proton pump. Conclusions: When comparing the results of laparoscopic and POEM of cardiomyotomy statistically significant differences were revealed. Thus, peroral endoscopic myotomy may be an analogue of laparoscopic cardiomyotomy.