Comparison of Manometric Changes in Achalasia Pre & Post Poem Procedure
Authors: Youssef Khaled Hamdy Abdel Mageed , Saad Hany Haroun Kaisar , Elkholy Shimaa Mohamed Abd El Monem , Meleak Gina Gamal Naguib , El-Aleem Mabrouk Shady Mohammed Abd 
Published: November 2024

Abstract

Background
Achalasia is characterized by the absence of peristaltic movement in the lower esophageal sphincter, resulting in impaired relaxation during food ingestion. The incidence of achalasia is similar between men and women, affecting approximately 1 in 100,000 individuals annually, with a prevalence of 10 in 100,000 people. It is most commonly diagnosed in individuals between the ages of 30 and 60 years. High-resolution esophageal manometry is considered the gold standard for diagnosis, revealing esophageal body aperistalsis and hypertensive lower esophageal sphincter. While laparoscopic myotomy has been the standard treatment, peroral endoscopic myotomy (POEM) has emerged as a safe and effective alternative with positive short-term and medium-term outcomes.

Aim of the Work
The aim of this study was to evaluate the changes in esophageal motility following POEM in patients with achalasia by conducting repeated high-resolution esophageal manometry after the procedure. The study focused on patients diagnosed with achalasia using UGI endoscopy, barium swallow, and high-resolution esophageal manometry, with an Eckardt score above 3.

Methods
A total of 21 patients participated in the study, with a mean age of 35.23±7.2 years. Females accounted for 61.9% of the sample, and the mean height was 164.66±10.5 cm. Clinical symptoms assessed included dysphagia, retrosternal pain, regurgitation, and weight loss. Additionally, previous medical history, pneumatic dilatation, and Heller's myotomy were documented. The type of achalasia was classified as type I or type II. Key parameters of lower esophageal sphincter (LES) relaxation were analyzed pre- and post-POEM.

Results
All patients presented with dysphagia, retrosternal pain, and regurgitation, while 71.4% experienced weight loss. Four patients (19.1%) had type I achalasia, and 17 patients (80.9%) had type II achalasia. Significant differences were observed between pre-POEM and post-POEM measurements of integrated relaxation pressure (IRP) and LES parameters, as well as Eckardt scores. However, no statistically significant differences were found in weight and LES length between pre- POEM and post-POEM measurements. The type of achalasia did not significantly impact LES parameters pre- and post-POEM. Eckardt score, IRP, and LES length were identified as relevant predictors of the outcome in achalasia patients.

Conclusion
Peroral endoscopic myotomy (POEM) effectively reduces lower esophageal sphincter pressure in achalasia and partially restores esophageal body motility. It represents an advanced therapeutic- surgical endoscopic procedure with high short-term and medium-term success rates in treating achalasia and other esophageal motor disorders. Adverse events associated with POEM are minor and easily manageable. POEM is considered a safe and feasible treatment option for different types of achalasia. However, the efficacy of POEM may not be reflected by the clinical subtypes of achalasia.