Per-oral Endoscopic Myotomy for Treatment of Achalasia, A Single Center Case Series
Keywords:
Per-oral endoscopic myotomy (POEM), Achalasia, Eckardt scoreAbstract
Introduction: Achalasia is a rare esophageal motility disorder with multiple modality of treatment, however, a novel treatment with per-oral endoscopic myotomy (POEM) have recently gained recognition as a standard of care.
Objective: To evaluate the early outcomes and complications of per-oral endoscopic myotomy (POEM) in Nakornping Hospital.
Materials and Methods: A retrospective observational study of medical record reviewed all patients diagnosed with achalasia and was treated with POEM between August 2018 and March 2025. Patient demographic data, early outcomes and complications were evaluated. A follow up of at least 1 year data was collected.
Results: A total of 14 patients were included. Technical success was achieved in 92.8% (13/14) of cases, with one conversion to endoscopic dilatation due to bleeding. The median operative time was 162.5 minutes. Overall morbidity was 28.5% (n=4), including one perforation controlled with endoscopic clips, one bleeding event, and two cases of aspiration pneumonia. The median length of stay was 4 days. At 1-year follow-up, clinical success was evident as the median Eckardt score significantly improved from 7 preoperative to 1 (range: 0–3). Additionally, timed-barium esophagography measurements improved, and median BMI increased from 19.6 to 21.4 kg/m².
Conclusion: Per-oral endoscopic myotomy (POEM) is a safe and effective treatment of achalasia with proficient 1 year outcome. However a long-term follow is warrent for evaluation.
References
Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108(8):1238-49.
Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet. 2014;383(9911):83-93.
Eckardt VF. Clinical presentation and complications of achalasia. Gastrointest Endosc Clin N Am. 2001;11(2):281-92.
Yadlapati R, Kahrilas PJ, Fox MR, Bredenoord AJ, Prakash Gyawali C, Roman S, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0((c)). Neurogastroenterol Motil. 2021;33(1):e14058.
Yadlapati R, Kahrilas PJ, Fox MR, Bredenoord AJ, Prakash Gyawali C, Roman S, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0. Neurogastroenterol Motil. 2021;33(1):e14058.
Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135(5):1526-33.
Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstätter M, Lin F, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009;249(1):45-57.
Inoue H, Kudo SE. Per-oral endoscopic myotomy (POEM) for 43 consecutive cases of esophageal achalasia. Nihon Rinsho. 2010;68(9):1749-52.
Inoue H, Onimaru M, Yokoyama N. Endoscopic Treatment for Esophageal Achalasia: Per-oral Endoscopic Myotomy (POEM). Kyobu Geka. 2024;77(10):896-901.
Werner YB, Hakanson B, Martinek J, Repici A, von Rahden BHA, Bredenoord AJ, et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. N Engl J Med. 2019;381(23):2219-29.
Dahiya DS, Pinnam BSM, Chandan S, Ali H, Gangwani MK, Sohail AH, et al. Comparison of peroral endoscopic myotomy, laparoscopic Heller myotomy, and pneumatic dilation for patients with achalasia: a United States national experience. Clin Endosc. 2025;58(1):153-7.
Shimamura Y. Advancing the management of achalasia with peroral endoscopic myotomy (POEM) versus pneumatic balloon dilation: Is POEM the superior choice? Gastrointest Endosc. 2025;101(3):568-9.
Shally L, Saeed K, Berglund D, Dudash M, Frank K, Obradovic VN, et al. Clinical and financial outcomes of per-oral endoscopic myotomy compared to laparoscopic heller myotomy for treatment of achalasia. Surg Endosc. 2023;37(7):5526-37.
Hayat U, Kamal F, Memon A, Sadiq SM, Rana UI, Gangwani MK, et al. Peroral Endoscopic Myotomy for Achalasia Among the Elderly Population: A Systematic Review and Meta-Analysis. J Clin Gastroenterol. 2025.
Kuipers T, Mussies C, Lei A, Masclee GMC, Benninga MA, Fockens P, et al. Peroral Endoscopic myotomy (POEM) in pediatric achalasia: a retrospective cohort on institutional experience and quality of life. Orphanet J Rare Dis. 2025;20(1):39.
Hugova K, Mares J, Hakanson B, Repici A, von Rahden BHA, Bredenoord AJ, et al. Per-oral endoscopic myotomy versus laparoscopic Heller's myotomy plus Dor fundoplication in patients with idiopathic achalasia: 5-year follow-up of a multicentre, randomised, open-label, non-inferiority trial. Lancet Gastroenterol Hepatol. 2025;10(5):431-41.
Teh JL, Tham HY, Soh AYS, Chee C, Kim G, Shabbir A, et al. Gastro-esophageal reflux disease (GERD) after peroral endoscopic myotomy (POEM). Surg Endosc. 2022;36(5):3308-16.
Nagi TK, Suarez ZK, Haider MA, Holder SS, Vallejo C, Chaudhari SS. Per-Oral Endoscopic Myotomy-Induced Gastroesophageal Reflux Disease and Review of the Efficacy of Proton Pump Inhibitors as a Management Strategy: Review of the Literature. Cureus. 2023;15(12):e50324.
Samarasam I, Joel RK, Pulimood AB. Gastroesophageal reflux following per-oral endoscopic myotomy: Can we improve outcomes? World J Gastroenterol. 2024;30(22):2834-8.
Tawheed A, Bahcecioglu IH, Yalniz M, El-Kassas M. Gastroesophageal reflux after per-oral endoscopic myotomy: Management literature. World J Gastroenterol. 2024;30(23):2947-53.
Kumbhari V, Tieu AH, Onimaru M, El Zein MH, Teitelbaum EN, Ujiki MB, et al. Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open. 2015;3(3):E195-201.
Zaninotto G, Bennett C, Boeckxstaens G, Costantini M, Ferguson MK, Pandolfino JE, et al. The 2018 ISDE achalasia guidelines. Dis Esophagus. 2018;31(9):doy071.
Moonen A, Boeckxstaens G. Management of achalasia. Gastroenterol Clin North Am. 2013;42(1):45-55.
