Skip to main content
SpringerLink
Log in

Per-oral endoscopic myotomy (POEM) for a sigmoid type of achalasia: short-term outcomes and changes in the esophageal angle

  • 2019 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Per-oral endoscopic myotomy (POEM) is an endoscopic procedure whereby the esophageal muscle is incised in order to lower the lower esophageal sphincter (LES) pressure. Since the time it was first performed in 2008 and subsequently reported on in 2010 by Inoue et al., POEM has been shown to be safe and effective for straight type of achalasia. On the other hand, the efficacy of POEM had been controversial for patients with achalasia of the sigmoid type, in which a high LES pressure is accompanied by morphological changes, including dilation, acute angulation, and rotation. The aim of this study is to evaluate the safety and efficacy of POEM in patients with sigmoid type of achalasia.

Methods

Between May 2015 and December 2017, 16 patients with a sigmoid type of achalasia underwent POEM in our institute. The POEM procedure was the same as that for the straight type of achalasia. The double-scope technique was used to check the distal end of the submucosal tunnel from the gastric side. The primary endpoint was improvement of Eckardt score at 2 months after POEM. The secondary endpoints comprised operating time, change in the esophageal angulation, and adverse events.

Results

All patients underwent POEM without severe adverse events. The respective parameters before and after POEM significantly differed in terms of mean (SD) Eckardt score [4.9 (2.0) vs. 0.4 (0.6), p < 0.01], LES pressure [19.4 (10.2) vs. 9.2 (6.4), p < 0.01], and integrated relaxation pressure [17.6 (9.2) vs. 7.9 (5.5), p < 0.01]. The average operation time was 94.7 ± 31.4 min. The average esophageal angulation was 88.4° ± 23.1° before POEM and 109.5° ± 16.7° after POEM (p < 0.01). Four patients had postoperative complications that were treated conservatively.

Conclusions

POEM can improve both LES pressure and esophageal angulation in patients with sigmoid achalasia.

Graphic abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Francis DL, Katzka DA (2010) Achalasia: update on the disease and its treatment. Gastroenterology 39:369–374

    Article  Google Scholar 

  2. Boeckxstaens GE, Zaninotto G, Richter JE (2014) Achalasia. Lancet 383:83–93

    Article  Google Scholar 

  3. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271

    Article  CAS  Google Scholar 

  4. Von Renteln D, Fuchs KH, Fockens P (2013) Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology 145:309–311

    Article  Google Scholar 

  5. Patel K, Abbassi-Ghadi N, Markar S, Kumar S, Jethwa P, Zaninotto G (2016) Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis. Dis Esophagus 29:807–819

    Article  CAS  Google Scholar 

  6. Youn YH, Minami H, Chiu PW, Park H (2016) Peroral endoscopic myotomy for treating achalasia and esophageal motility disorders. J Neurogastroenterol Motil 22:14–24

    Article  Google Scholar 

  7. Li H, Peng W, Huang S, Ren Y, Peng Y, Li Q, Wu J, Fu X, Tang X (2019) The 2 years’ long-term efficacy and safety of peroral endoscopic myotomy for the treatment of achalasia: a systematic review. J Cardiothorac Surg 14:1

    Article  Google Scholar 

  8. Shiino Y, Houghton SG, Filipi CJ, Awad ZT, Tomonaga T, Marsh RE (1999) Manometric and radiographic verification of esophageal body decompensation for patients with achalasia. J Am Coll Surg 189:158–163

    Article  CAS  Google Scholar 

  9. Japan Esophageal Society (2017) Descriptive rules for achalasia of the esophagus. June 2012 (The 4th edition). Esophagus 14:275–289

    Article  Google Scholar 

  10. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE, International High Resolution Manometry Working Group (2015) The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 27:160–174

    Article  CAS  Google Scholar 

  11. Grimes KL, Inoue H, Onimaru M, Ikeda H, Tansawet A, Bechara R, Tanaka S (2016) Double-scope per oral endoscopic myotomy (POEM): a prospective randomized controlled trial. Surgl Endosc 30:1344–1351

    Article  Google Scholar 

  12. Hong H, Song GW, Ko WB, Kim WH, Hahm KB, Hong SP, Cho JY (2016) Double-scope peroral endoscopic myotomy (POEM) for esophageal achalasia: the first trial of a new double scope POEM. Clin Endosc 49:383–386

    Article  Google Scholar 

  13. Inoue H, Shiwaku H, Iwakiri K, Onimaru M, Kobayashi Y, Minami H, Sato H, Kitano S, Iwakiri R, Omura N, Murakami K, Fukami N, Fujimoto K, Tajiri H (2018) Clinical practice guidelines for peroral endoscopic myotomy. Dig Endosc 30:563–579

    Article  Google Scholar 

  14. Katayama H, Kurosawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, Tsubosa Y, Satoh T, Yokomizo A, Fukuda H, Sasako M (2016) Extended Clavien–Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today 46:668–685

    Article  Google Scholar 

  15. Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP, Lundell L, Margulies M, Richter JE, Spechler SJ, Tytgat GN, Wallin L (1996) The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology 111:85–92

    Article  CAS  Google Scholar 

  16. Mattioli S, Di Simone MP, Bassi F, Pilotti V, Felice V, Pastina M, Lazzari A, Gozzetti G (1996) Surgery for esophageal achalasia: long-term results with three different techniques. Hepatogastroenterology 43:492–500

    CAS  PubMed  Google Scholar 

  17. Howerd JM, Ryan L, Lim KT, Reynolds JV (2011) Oesophagectomy in the management of end-stage achalasia: case reports and a review of the literature. Int J Surg 9:204–208

    Article  Google Scholar 

  18. Devaney EJ, Iannettoni MD, Orringer MB, Marshall B (2001) Esophagectomy for achalasia. Patient selection and clinical experience. Ann Thorac Surg 72:632–637

    Article  Google Scholar 

  19. Molena D, Yang SC (2012) Surgical management of endo-stage achalasia. Semin Thorac Cardiovasc Surg 24:19–26

    Article  Google Scholar 

  20. Hu JW, Li QL, Zhou PH, Yao LQ, Xu MD, Zhang YQ, Zhong YS, Chen WF, Ma LL, Qin WZ, Cai MY (2015) Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long term outcomes from a prospective, single-center study. Surg Endosc 29:2841–2850

    Article  Google Scholar 

  21. Tuboi K, Omura N, Yano F, Hoshino M, Yamamoto SR, Akimoto S, Masuda T, Kashiwagi H, Yanaga K (2017) Impact of esophageal flexion level on the surgical outcome in patients with sigmoid esophageal achalasia. Surg Today 47:1339–1346

    Article  Google Scholar 

  22. Bechara R, Onimaru M, Ikeda H, Inoue H (2016) Per-oral endoscopic myotomy, 1000 cases later: pearls, pitfalls, and practical considerations. Gastrointest Endosc 84:330–338

    Article  Google Scholar 

  23. Lv L, Liu J, Tan Y, Liu D (2016) Peroral endoscopic full-thickness myotomy for the treatment of sigmoid-type achalasia: outcomes with a minimum follow-up of 12 months. Eur J Gastroenterol Hepatol 23:30–36

    Article  Google Scholar 

  24. Eleftheriadis N, Inoue H, Ikeda H, Onimaru M, Maselli R, Santi G (2016) Submucosal tunnel endoscopy: peroral endoscopic myotomy and peroral endoscopic tumor resection. World J Gastrointest Endosc 8:86–103

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Hachinohe City Hospital, 3-1-1 Tamukai, Hachinohe, Aomori, 031-8555, Japan

    Shota Maruyama

  2. Department of Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan

    Yusuke Taniyama, Tadashi Sakurai, Makoto Hikage, Chiaki Sato, Kai Takaya, Takuro Konno, Takeshi Naitoh, Michiaki Unno & Takashi Kamei

Authors
  1. Shota Maruyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yusuke Taniyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tadashi Sakurai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Makoto Hikage
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chiaki Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kai Takaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takuro Konno
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takeshi Naitoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michiaki Unno
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takashi Kamei
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shota Maruyama.

Ethics declarations

Disclosures

Shota Maruyama, Yusuke Taniyama, Tadashi Sakurai, Makoto Hikage, Chiaki Sato, Kai Takaya, Takuro Konno, Takeshi Naitoh, Michiaki Unno, and Takashi Kamei have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maruyama, S., Taniyama, Y., Sakurai, T. et al. Per-oral endoscopic myotomy (POEM) for a sigmoid type of achalasia: short-term outcomes and changes in the esophageal angle. Surg Endosc 34, 4124–4130 (2020). https://doi.org/10.1007/s00464-019-07180-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-07180-4

Keywords

Search

Navigation