Peroral endoscopic myotomy (POEM) for the treatment of achalasia: A multicenter Middle Eastern experience
Abed Al Lehibi1, Shaimaa Elkholy2, Mohamed Gouda3, Ammar Al Dabbagh1, Areej Al Balkhi1, Abdullah Almtawa1, Nawwaf Al Otaibi1, Mohammed El-Sherbiny2, Kareem Essam2, Mohammed Attieh Alzahrani4, Ahmed Al Ghamdi1, Adel Al Ghamdi1, Ahmad AlEid1, Adel Qutub1, Abdulrahman Alamr1, Shameem Ahmad1, Khalid Al Sayari1, Bashaar Al Ibrahim1, Abdullah Al Khathlan1, Resheed Eid Alkhiari5
1 Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
2 Gastroenterology Division, Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
3 Department of Internal Medicine, Gastroenterology, Mouwasat Hospital, Dammam, Saudi Arabia
4 College of Medicine, King Khalid University; Gastroenterology Division, Department of Internal Medicine, Asir Central Hospital, Abha, Saudi Arabia
5 Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh; College of Medicine, Qassim University, Buraydah, Saudi Arabia
Abed Al Lehibi,
Department of Gastroenterology and Hepatology, King Fahad Medical City, P.O. Box 59046, Riyadh - 11525
Source of Support: None, Conflict of Interest: None
Background: Peroral endoscopic myotomy (POEM) was proposed in 2010 as a minimally invasive procedure for the treatment of achalasia. In this article, we describe the Middle Eastern experience with the procedure in terms of efficacy, length of admission, and short- and long-term complications.
Methods: A retrospective analysis of our prospectively collected data on patients who underwent a POEM procedure was conducted between March 2019 and May 2020. The primary outcome was clinical success rate, defined as a postprocedure Eckardt score ≤3 at ≥3 months. Secondary outcomes included the length of hospital stay, presence of reflux symptoms or need for proton pump inhibitors (PPIs) ≥3 months, and adverse events.
Results: During the study period, 67 patients (35 females) underwent the procedure for achalasia. The participants' ages ranged from 11 to 80 years (mean 41 ± 18 years). Eckardt scores before the treatment ranged between 4 and 12 (mean 8.85 ± 1.75). Sixty-four patients (95.5%) achieved Eckardt scores of ≤3 at ≥3 months after the procedure (95% confidence interval [CI]: 91%–100%). The difference between pre- and post-procedural Eckardt scores averaged around -8 points (95% CI: −7.5 to -8.5 P < 0.0001). Adverse events were reported in 24 patients (35.8%) and included pneumoperitoneum (32.8%), reflux symptoms at 3 months (29.9%), and surgical emphysema (3%). Six patients had adverse events that led to prolongation of admission; 3% of whom had aspiration pneumonia, 3% had pneumoperitoneum, 1.5% had both, and 1.5% had an esophageal tear.
Conclusions: POEM is a promising procedure for the treatment of achalasia with a high clinical success rate, short hospital admission, and a reassuring safety profile.