Efficacy of peroral endoscopic myotomy compared with other invasive treatment options for the different esophageal motor disorders

Abstract

Short-term outcomes are similar to laparoscopic Heller myotomy (LHM) and pneumatic endoscopic dilation (PD) (clinical success > 90%) for achalasia subtypes I and II. Mid-term outcomes are comparable to LHM and overcome the results obtained after PD (> 90% vs ~50%). With regard to type III achalasia, POEM efficacy is 98% compared to 80.8% for LHM and the PD success remains at 40%. With regard to spastic esophageal disorders (SED), POEM has an effectiveness of 88% and 70% for distal esophageal spasm (DES) and jackhammer esophagus (JE) respectively. A response of 95% in patients with sigmoid esophagus has been reported. POEM has been performed in pediatric and elderly populations and has obtained a higher efficacy than PD in pediatric series (100% vs 33%) without greater adverse events. Previous treatments do not seem to hinder POEM results with excellent response rates, including 97% in post LHM and 100% in a re-POEM series. Final considerations: POEM has shown excellent short and mid-term results for all subtypes of achalasia but long-term results are not yet available. The promising results in SED may make POEM the first-line treatment for SED. A high-safety profile and efficacy have been shown in elderly and pediatric populations. Previous treatments do not seem to diminish the success rate of POEM. Core tip: POEM has emerged as an efficient treatment option for all subtypes of achalasia and other scenarios (including previous treatments and elderly and pediatric populations). Short and mid-term results are comparable to LHM and are better than PD data. The clinical response rate of DES and JE may make POEM the first-line treatment for SED.

POEM: Five Years of Experience in a Single East European Center

“…Endoscopic myotomy can be performed on the posterior wall or on the opposite side of the initial incision, with good results regarding symptom regression and no additional adverse events [5,21,[24][25][26][27][28], certifying that previous treatment does not necessarily influence the therapeutic failure. These results were confirmed by other studies as well [7,15,27,29].…”

How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective

“…Since 2008, POEM has proven its efficacy in the treatment of achalasia and it is now considered an alternative first-line therapy by many. POEM can be offered for different esophageal diseases 20 21 22 23 24 25 , is cost-saving 26 , and provides a longer myotomy 21 , with similar long-term benefits as compared to HM 27 28 , while reducing post-procedural pain 29 . In addition, endoscopic myotomy has proven to be a promising technique folr other esophageal conditions, such as Jackhammer esophagus 30 and as a “salvation technique” for patients with recurrent symptoms after HM 31 32 33 .…”

Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation

“…Proton pump inhibitors can be used in patients with JE [7]. Potential endoscopic approaches are botulinum toxin injection [7, 10], pneumatic dilation [7], and peroral endoscopic myotomy (POEM) [7, 11]. In the study mentioned above, where a patient with JE was found to have an eosinophilic infiltration of the muscularis propria, prednisone was used in combination with POEM [8].…”