Minimally invasive interventions for esophageal achalasia stage III and IV (evaluation of immediate and long term results)

Purpose of a study: to evaluate the immediate and remote results of minimally invasive interventions in patients with achalasia cardia.

Material and methods. The study included 104 patients with achalasia cardia stage III and IV: 44 men (42.3%), 60 women (57.7%), aged from 20 to 72 years (44.5 (40.0; 64.0)) who underwent peroral endoscopic myotomy (POEM). In order to evaluate the effectiveness of POEM, its effectiveness was compared with data on the immediate and remote results of laparoscopic intervention - esophagocardiofundoplasty (ECFP) (51 patients).

Results. The duration of the postoperative period in the group after POEM was on average 3.5 days (47.3%) shorter, the total duration of hospitalization was 4.4 days (42.3%) shorter than in patients after ECFP. Over a period of more than 1 year, the dysphagia index according to the Eckardt scale in patients in the POEM group was 30.7% lower. Recurrence in the group of patients after ECFP was more frequent than after POEM (5 versus 1 (p = 0.021). The gastroesophageal reflux rate was 10.4% lower after POEM, and the reflux rate after POEM was 2 times lower. In the late postoperative periods, the GIQLI questionnaire scores in patients after POEM were significantly better compared to these scores in the group of patients who underwent ECFP.

Conclusion. POEM made it possible to significantly reduce both the duration of the postoperative period and the total duration of hospitalization, and complications that occurred in the early postoperative period were milder. The results of patient questionnaires using the Eckardt and GIQLI questionnaires at 6 months and more than 1 year, as well as the recurrence rate of achalasia cardia, indicate the high efficiency of POEM. Further evaluation of the results of minimally invasive interventions in patients with achalasia cardia is necessary.

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