Introduction:

Achalasia is an esophageal motor disorder characterized by failure in esophageal peristalsis as well as relaxation of the lower esophageal sphincter (LES) in response to swallowing (1). It is a rare pathology, with an incidence ranging from 0.3-1.63 per 100,000 adults/year and a prevalence of 8.7-10.8 per 100,000 inhabitants (2). The treatment of Achalasia is not curative, but the objective is to reduce the resistance to flow caused by the lack of relaxation in the LES (3). In 2010, Inoue et al described the technique of per oral endoscopic myotomy (POEM) performed in 17 patients with excellent results in terms of resolution of dysphagia (7). Nine years after the description of the POEM technique for endoscopic treatment, nowadays in Mexico, there are few centers that perform it.

Objective:

To present the initial experience of the Per-Oral Endoscopic Myotomy (POEM) procedure performed for the treatment of Achalasia in the General Hospital “Dr. Manuel Gea González”.

Materials and methods:

A review of the Gastrointestinal Endoscopy Service database of the General Hospital “Dr. Manuel Gea González” in search of patients who underwent a POEM procedure for the treatment of Achalasia in the last 3 years. We analyzed demographic characteristics of the patients, classification of the type Achalasia, Eckardt scale before and after the procedure, manometry before and after the procedure, length of the myotomy, surgical time, days of hospital stay, 24hr pH testing before and after the procedure and complications.

Results:

During the 3-year period, 11 patients underwent POEM technique for the treatment of Achalasia. Eight men and 3 women. Average age was 63 years (48-83). Predominant type of Achalasia was type I. Average Eckardt score prior to the POEM was 8 (7-10) in contrast to the average in the Eckardt score after the POEM was 1 (1-2). Mean surgical time was 2.6 hours (2-4) and the average number of days of hospital stay was 4.4 days (4-8). The mean length of the myotomy was 8.6 cm (7-10). The manometry after procedure showed improvement with respect to the previous one in 100% of the cases, contrary to the esophageal pH testing that showed abnormalities after the POEM in 27% of the patients. There were no major complications during and after the procedure.

Conclusions:

The POEM technique was performed effectively and safely in our patients, presenting an improvement in the resolution of dysphagia in 100% of cases. A significant percentage presented reflux after the POEM procedure that remitted with the use of proton pump inhibitors.

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