Peroral Endoscopic Myotomy for Type III Achalasia of Chicago Classification: Outcomes with a Minimum Follow-Up of 24 Months

INTRODUCTION: There are only few studies about the outcomes of peroral endoscopic myotomy (POEM) for type III achalasia in a relatively large population to date. The purpose of this study was to explore the long-term efficacy of POEM for patients with type III achalasia.

METHODS: There were a total of 32 consecutive patients with type III achalasia undergoing POEM in our hospital from July 2012 to October 2014. Clinical date of general characteristics, procedure-related parameters and adverse events, symptom relief, and the high-resolution manometry outcomes before and during the periodic follow-up were retrospectively collected and analyzed.

RESULTS: All of the 32 patients underwent POEM successfully with a median operation time of 34.9 min (range 17.9-88.6 min). No serious complications related to POEM were encountered. Treatment success was achieved in 90.6% cases during a median follow-up period of 27.0 months (range 24-51 months). The mean pretreatment and post-treatment Eckardt scores were 7.2 and 1.4, respectively (P < 0.001), and mean LES pressure also decreased from a mean of 39.2 to 19.0 mmHg after the procedure (P < 0.001). Both of the gas-related complication and clinical reflux complication rates were 18.8%.

CONCLUSION: Our results confirm that POEM for type III achalasia of Chicago Classification is effective with a long-term symptom relief in 90.6% cases. But a further, prospective study is needed to evaluate whether POEM outcome could be correlated with manometric subtypes according to Chicago Classification.