Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia

Gastrointest Endosc. 2013 Jul;78(1):39-44. doi: 10.1016/j.gie.2013.01.006. Epub 2013 Feb 26.


Background: Pneumatic dilation and laparoscopic Heller myotomy improve parameters of esophageal function such as lower esophageal sphincter (LES) pressure, esophageal emptying, and esophagogastric junction (EGJ) distensibility.

Objective: To evaluate the effect of peroral endoscopic myotomy (POEM) on esophagogastric function.

Design: Prospective trial.

Setting: Endoscopy department at a university hospital.

Patients: All consecutive patients aged >17 years with achalasia and an Eckardt score of ≥3.

Intervention: Before and 3 months after POEM, 10 consecutive patients underwent esophageal manometry, timed barium esophagograms, and EndoFLIP as well as an EGD.

Main outcome measurements: Eckardt symptom score, LES resting pressure, centimeters of barium stasis, EGJ distensibility, and reflux esophagitis.

Results: Compared with scores before POEM, patient symptom scores were significantly reduced (1, interquartile range [IQR 0-1] vs 8 [IQR 4-8]; P = .005). LES pressure decreased significantly (6.0 mm Hg [IQR 2.6-7.4] vs 19.0 mm Hg [IQR 13.0-28.0]; P = .008). Esophageal emptying increased significantly, and a 5-minute barium column measured 2.3 cm (IQR 0-3.2 cm) versus 10.1 cm (IQR 5.7-10.8 cm; P = .005). EGJ distensibility increased significantly (6.7 mm(2)/mm Hg [IQR 3.8-16.6] vs 1.0 mm(2)/mm Hg [IQR 0.4-2.3]; P = .02) at 50 mL. In 6 of 10 patients, reflux esophagitis was seen. Of these patients, 3 reported reflux symptoms.

Limitations: Small number of patients, short-term follow-up.

Conclusion: POEM improves esophagogastric function and suggests favorable long-term results based on Eckardt score, esophageal manometry, esophageal emptying, and EGJ distensibility. Long-term follow-up of larger series will determine whether the high rate of reflux esophagitis affects the clinical application of POEM.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Esophageal Achalasia / diagnosis
  • Esophageal Achalasia / surgery*
  • Esophageal Sphincter, Lower / physiopathology
  • Esophageal Sphincter, Lower / surgery*
  • Esophagogastric Junction / diagnostic imaging
  • Esophagogastric Junction / physiopathology
  • Esophagogastric Junction / surgery*
  • Esophagoscopy / methods*
  • Female
  • Follow-Up Studies
  • Hospitals, University
  • Humans
  • Male
  • Manometry
  • Middle Aged
  • Mouth
  • Natural Orifice Endoscopic Surgery / methods*
  • Prospective Studies
  • Radiography
  • Recovery of Function
  • Risk Assessment
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Treatment Outcome