ABSTRACT
BACKGROUND: Peroral endoscopic myotomy (POEM) is a recognized technique for patients with achalasia. We aimed to evaluate the feasibility of using a small-caliber endoscope (thin-POEM) to perform POEM in patients with achalasia. METHODS: Naïve or previously treated patients were included between February 2016 and April 2018.âA small-caliber (5.9âmm) nasoendoscope was used, with a modified closure method using cyanoacrylate. Strict follow-up was performed. RESULTS: 45 patients were included, aged 45.5 years (interquartile range [IQR] 22â-â69); 53â% (24/45) had type II achalasia. Median total time for thin-POEM was 54 minutes (IQR 37â-â77) and median myotomy length was 13.5âcm (IQR 6â-â20). Results pre-procedure and 3 months post were Eckardt score 10 vs. 1 (Pâ<â0.001), integrated relaxation pressure (IRP) 25.3 vs. 8.5âmmHg (Pâ<â0.001), and timed barium esophagram (TBE) 100â% severely delayed vs. 86â% normal (Pâ<â0.001), respectively. Type III patients had the longest thin-POEM times (median 58 minutes [IQR 52â-â77]). Reflux was confirmed at 3 months clinically in 17â% of patients, endoscopically in 20â%, and on pH monitoring in 53â%. At 6 months and 12 months, 40â% and 33â% of patients remained positive on pH monitoring and were medically managed. CONCLUSIONS: Thin-POEM seems to be a safe, effective, and efficient procedure for POEM in patients with achalasia, with good short-term follow-up results.