Saudi Journal of Gastroenterology
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ORIGINAL ARTICLE
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Peroral endoscopic myotomy (POEM) for the treatment of achalasia: A multicenter Middle Eastern experience


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

Correspondence Address:
Abed Al Lehibi,
Department of Gastroenterology and Hepatology, King Fahad Medical City, P.O. Box 59046, Riyadh - 11525
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjg.sjg_49_21

PMID: 34259191

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.


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