Per-Oral Endoscopic Myotomy: A Series of 500 Patients

Case series of 500 consecutive patients undergoing POEM from September 2008 through November 2013 at a tertiary referral center in Japan.  At 2 month follow-up, the success rate was 91.3% (defined as Eckardt score < 2 or reduced > 4 points). Two hundred sixty-eight patients had esophagitis on endoscopy (64.7%), but only 71 (16.8%) had reflux symptoms. At 1-2 years, the success rate was 91%, 9 of 16 patients has esophagitis on endoscopy, and 19.4% had heartburn symptoms. Lastly, at 3 years the success rate was 88.5%, again 9 of 16 patients had esophagitis on endoscopy, and 56.3% had heartburn symptoms. Complications occurred in 16 patients (3.2%), the most severe being 1 pneumothorax requiring a chest tube and 1 case of bleeding controlled endoscopically but requiring blood transfusion; there were no deaths. The authors point out that one advantage of POEM over Heller myotomy is that the length of the myotomy can be better tailored to the individual patient.