Original articleClinical endoscopyPeroral endoscopic myotomy for treatment of achalasia: from bench to bedside (with video)
Section snippets
Methods
This was a prospective study of the technical development and clinical application of a novel endoscopic procedure, POEM, for the treatment of achalasia. The technical steps to perform POEM are described in the following and were the same in the procedures in both animals and humans.
Preclinical animal studies
POEM was successfully performed in 2 nonsurvival porcine models. Seven 30-kg porcine models were then used in the survival study. The mean operating time was 45.1 (± 13.5) minutes. The healing of all mucosal entrances was confirmed with no evidence of leakage on the repeat endoscopy before the postmortem examination. All pigs survived for 1 week except 1 that died immediately after the procedure. There was extensive pneumomediastinum detected on the postmortem examination that led to tension
Discussion
The current study demonstrated the feasibility and safety in translating endoscopic techniques of POEM from animal study to clinical practice. The POEM technique was based on a similar principle as that of the Heller myotomy.2, 3, 12 The mean procedure time of POEM was 117.0 minutes, which is similar to that reported from Japan and Europe.6, 13, 14 All patients had relief of dysphagia with significant improvement in Eckhardt score at 3 months after POEM. The relief of dysphagia is accompanied
Acknowledgments
We are grateful to Professor Haruhiro Inoue, Yokohama, Japan, for his contribution in proctoring the first human case of POEM and his input in the conduct of the study.
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DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: Drs Chiu and Lau served as members of a research group sponsored by Olympus. The other authors disclose no financial relationships relevant to this publication. The prototype triangle-tip knife was provided by Olympus Co Ltd at no cost.
If you would like to chat with an author of this article, you may contact Dr Chiu at [email protected].