A stepwise approach for peroral endoscopic myotomy for treating achalasia: from animal models to patients

Abstract

Objectives. Peroral endoscopic myotomy (POEM) was initially developed for the treatment of achalasia. This study aimed to investigate the feasibility and safety of a stepwise approach for POEM in the management of achalasia. Methods. A total of five ex-vivo porcine esophagus-stomach training models were created and POEM was performed. Then, 25 patients with achalasia were treated similarly. The Eckardt score, barium esophagrams, and high-resolution manometry were used to evaluate its efficacy. Results. POEM procedures were completed in five stomach-esophagus models, with perforations in the initial three and success in the last two. A total of 36 achalasia patients (22 males, 14 females) with achalasia successfully underwent POEM. The mean operation time was 72.0 min (range, 45–180 min). There were two complications in three patients: one case of severe bleeding and two cases of pneumothorax, which were treated successfully. During the follow-up period, the median Eckardt score decreased dramatically from 8 to 1 (p = 0.000). The lower basal esophageal sphincter pressure (36.1 ± 14.3 vs. 11.9 ± 4.6 mmHg, p = 0.000), as well as the 4-s integrated relaxation pressure (12.9 ± 13.0 vs. 6.6 ± 2.9 mmHg, p = 0.000). Additionally, the maximum esophagus width was significantly reduced (mean reduced width: 1.6 ± 1.1 cm, p = 0.000). Conclusions. The ex-vivo porcine esophagus-stomach can be used as a simple and cheap training model that mimics the POEM procedure. POEM is a safe and effective therapy for achalasia patients.

Key Words:

• achalasia
• animal model
• peroral endoscopic myotomy

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Acknowledgments

This study was supported by a grant from the National Natural Science Foundation of China (No. 81101610).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.