[High-resolution esophageal manometry in endoscopic treatment of achalasia cardia].

OBJECTIVE

To present own experience in treating achalasia cardia using peroral endoscopic myotomy, safety and high efficacy of this method, as well as advantages of peroral endoscopic myotomy (POEM).

MATERIAL AND

METHODS

The study enrolled 129 patients between August 2017 and January 2025 who underwent POEM. Surgery was performed using standard technique at a distance of approximately 20-25 cm from incisors. After creating a hydraulic cushion with indigo carmine-stained gelofusine, we made longitudinal incision for 1.5-2.0 cm using electrosurgical stand and electric knife. After entering submucosal layer, we created a tunnel to subcardia level. Myotomy was then performed 7-8 cm before the cardia and 2-3 cm after it. Hemostasis was achieved if necessary, and mucosal defect was closed with endoscopic clips.

RESULTS

According to the Eckardt scale, we obtained excellent results in 66 (51.2%) patients and satisfactory results in 55 (42.7%) patients. Unsatisfactory results were observed in 5 (3.8%) patients, poor results - in 3 (2.3%) patients. Among 8 patients with unsatisfactory and poor results, 6 ones had recurrent achalasia, and 2 ones had stage 4 achalasia. Eight patients had access to high-resolution manometry before and after surgery that allowed for clear picture of improvement after POEM.

CONCLUSION

POEM demonstrates excellent results. Most patients experience significant regression or disappearance of dysphagia. Furthermore, POEM offers significant cosmetic benefits, as it eliminates postoperative skin scarring.