Peroral endoscopic myotomy for achalasia: a prospective multicenter study in Japan

Abstract Background and Aims Peroral endoscopic myotomy (POEM) is one of the available treatment modalities for achalasia. The reported efficacy of POEM in the only prospective multicenter study was 82%, reported by Von Renteln et al; however, a retrospective multicenter study in Japan reported a higher efficacy rate of 95%. The aim of this study was to prospectively verify treatment outcomes after POEM at multiple facilities in Japan. Methods This was a prospective single-arm trial of POEM for achalasia at eight facilities in Japan between April 2016 and March 2018 to evaluate its safety and efficacy. Patients were re-evaluated at 3 months and up to 1 year after POEM. Results Among the 233 patients with achalasia who underwent POEM, procedure-related adverse events occurred in 24 (10.3%) patients, none of whom required surgical intervention. In the 207 patients satisfying the inclusion criteria after the study by Von Renteln et al, the efficacy rate of POEM, defined by an Eckardt score ≤3 at 1 year, was 97.4% (95.3%–99.7%). The Eckardt score decreased significantly from 6.6 ± 2.0 preoperatively to 1.1 ± 1.1, 1 year after POEM. Postoperative reflux esophagitis, severe reflux esophagitis, and symptomatic gastroesophageal reflux disease were reported in 54.2%, 5.6%, and 14.7%, respectively, and proton pump inhibitors were administered in 21.1%. Conclusions Our prospective multicenter study in Japan showed greater efficacy of POEM for achalasia compared with the results of a previous prospective multicenter study. POEM is safe and highly effective for at least 1 year.