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Canadian Journal of Gastroenterology and Hepatology
Volume 2016, Article ID 2656101, 6 pages
Clinical Study

Two-Person Technique of Peroral Endoscopic Myotomy for Achalasia with an Advanced Endoscopist and a Thoracic Surgeon: Initial Experience

1Department of Gastroenterology, Cleveland Clinic, Cleveland, OH 44195, USA
2Department of Thoracic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA

Received 26 December 2015; Revised 19 June 2016; Accepted 20 July 2016

Academic Editor: Michael Beyak

Copyright © 2016 Madhusudhan R. Sanaka et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background and Aims. We initiated peroral endoscopic myotomy (POEM) utilizing a two-person technique with combination of an advanced endoscopist and a thoracic surgeon with complementary skills. Our aim was to determine the feasibility and outcomes in initial 20 patients. Methods. In this observational study, main outcomes measured were therapeutic success in relieving symptoms (Eckardt score < 3), decrease in lower esophageal sphincter (LES) pressures, improvement in emptying on timed barium esophagogram (TBE), and complications. Results. POEM was successful in all 20 patients with a mean operative time of minutes. Eckardt symptom scores decreased significantly at two-month follow-up ( versus , ). Both basal and residual LES pressures decreased significantly ( mmHg versus and versus  mmHg, and <0.001, resp.). Barium column height at 5 minutes on TBE reduced from  cm to  cm (). Two patients (10%) had mucosal perforations and one had delayed bleeding (5%). Conclusions. Two-person technique of POEM with combination of an advanced endoscopist and a thoracic surgeon is highly successful with low risk of complications.