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.