Peroral endoscopic myotomy: a literature review and the first UK case series

Abstract

Peroral endoscopic myotomy (POEM) is an established treatment for primary achalasia. It has gained endorsement from the American Society for Gastrointestinal Endoscopy with increasing clinical acceptance since the fi rst procedure, performed in Japan in 2008. The fi rst successful POEM in the UK was performed in November 2013 at King's College Hospital and this article presents the fi rst UK case series. Prospective data were collected at 3 and 12-24 months for consecutive patients undergoing POEM. Post-POEM gastro-oesophageal refl ux health-related quality of life scale (GORD-HRQoL) score was recorded. Statistical comparisons were made using paired non-parametric testing. In an initial series of 33 consecutive prospectively followed patients (12 female; 49.5±13 years; median follow-up 9 (3-28) months; 58% having had previous intervention), a 91% success rate has been achieved at 3 months. To date, 16 patients have reached the 12-month time point, with 13 (81%) sustaining response. This case series compares well with international cohorts and demonstrates excellent long-term safety and favourable effi cacy.

Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up

“…748 records were screened, and 88 full-length articles were assessed. Sixty-six studies 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 were included in the final analysis, four of which directly compared outcomes of POEM to PD 32 35 36 38 . A total of 29 studies reported on the outcomes of POEM 24 …”

“…In the 4 studies that compared POEM to PD 32 35 36 38 , 142 patients were treated by POEM and 157 patients were treated by PD. Whereas in the cohort studies, 29 studies including 2919 patients reported on POEM 24 25 26 27 28 30 31 33 34 37 39 40 41 42 43 44 45 51 63 65 73 77 78 79 80 85 87 92 , and 33 studies including 3050 patients reported on PD 46 48 49 50 52 53 54 55 56 57 58 59 60 61 62 64 66 67 68 69 70 71 72 74 75 76 81 82 84 86 88 89 .…”