Efficacy of peroral endoscopic myotomy compared with other invasive treatment options for the different esophageal motor disorders
2017
Introduction: Peroral endoscopic myotomy (POEM) has been
performed since 2008 on more than 5,000 patients. It has proven
to be highly effective in the treatment of achalasia and has shown
promising outcomes for other esophageal motility spastic disorders.
Methods: A literature review of the efficacy of POEM compared
to the previous invasive treatments for different esophageal motility
disorders was performed. The application in the pediatric and
elderly populations and its role as a rescue therapy after other
procedures are also outlined.
Results: 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 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 midterm
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.
Keywords:
- Correction
- Source
- Cite
- Save
- Machine Reading By IdeaReader
1
References
8
Citations
NaN
KQI