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Peroral endoscopic myotomy (POEM) for complex achalasia and the POEM difficulty score
Author(s) -
Bechara Robert,
Woo Matthew,
Hookey Lawrence,
Chung Wiley,
Grimes Kevin,
Ikeda Haruo,
Onimaru Manabu,
Sumi Kazuya,
Nakamura Jun,
Hata Yoshitaka,
Maruyama Shota,
Gomi Kuniyo,
Shimamura Yuto,
Inoue Haruhiro
Publication year - 2019
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.13294
Subject(s) - achalasia , myotomy , medicine , sigmoid function , surgery , adverse effect , esophagus , machine learning , artificial neural network , computer science
Background Peroral endoscopic myotomy ( POEM ) for achalasia is technically challenging to carry out in patients with type III , multiple prior treatments, prior myotomy, and sigmoid type. Herein, we present a series of consecutive patients with complex achalasia and introduce the POEM difficulty score ( PDS ). Aim To demonstrate the application and discuss the utility of PDS and present the feasibility, safety, and efficacy of POEM in complex achalasia patients. Methods Forty consecutive POEM were carried out with 28 meeting the criteria for complex achalasia. Primary outcome was clinical success (Eckardt score ≤3) at a minimum of 3 months follow‐up. Secondary outcomes included adverse events, procedural velocity and PDS . Results Twenty‐eight complex and 12 non‐complex POEM procedures were carried out with 100% and 92% clinical success, respectively, without any major adverse events with a median follow up of 15 months (complex) and 8 months (non‐complex). Mean velocities for non‐complex, type III , prior myotomy, ≥4 procedures and sigmoid type were as follows: 4.4 ± 1.6, 4.8 ± 1.5, 5.9 ± 2.2, 6.9 ± 2.2 and 8.2 ± 3.2 min/cm, respectively. Median PDS for non‐complex, type III , prior myotomy, ≥4 treatments and sigmoid type were 1 (0–3), 2 (0–4), 2.5 (1–6), 3 (2–6) and 3.5 (1–6), respectively. PDS was shown to correlate well with procedural velocity with a correlation coefficient of 0.772 (Spearman's P < 0.001). Conclusions PDS identifies the factors that contribute to challenging POEM procedures and correlates well with procedural velocity. The order of increasing difficulty of POEM in complex achalasia appears to be type III , prior myotomy, ≥4 treatments and sigmoid type.