Per-oral endoscopic myotomy: Major advance in achalasia treatment and in endoscopic surgery

Table 1 Overview of peroral endoscopic myotomy efficacy and gastro-esophageal reflux disease data

Location primary investigator	Patients (n)	Mean age (yr)	Eckardt score (pre/post)	LES pressure (pre/post) (mmHg)	Follow-up (mo)	Timed barium esophagram	Efficacy	Objective GERD evidence n (%)
Costamagna et al[34], Rome, Italy	11	41 (23-68)	7.1/1.1	45.1/16.9	3		100%
Swanstrom et al[13], Portland, Oregon	18	59 (22-88)	6/0	45/16.8	6	Median emptying at 5 min 15/16: 80%-100% emptying 1/16 less than 80% emptying	94%	Esophagitis (Grade 1 Savory-Miller classification)
								4/14 (28)
								+pH study
								6/13 (46)
Chiu et al[35], Hong Kong, China	16	47 (22-87)	5.5/0	43.6/29.8	3		100%	+pH study 3/15 (20)
Hungness et al[36], Chicago, Illinois	18	38 (22-69)	7/1	19/9	63	Median height	89%	Esophagitis
						1 min 7 cm (0-15 cm)		Los Angeles (LA) class
						2 min 5 (0-13 cm)		A 2/15 (13.3)
						5 min 0 (0-9 cm) (P < 0.001)		B 2/15 (13.3)
								C 1/15 (6.7)
Minami et al[37], Nagasaki, Japan	28	52 (19-84)	6.7/0.7	71.2/21	163		100%	Esophagitis (11/28) 39.3%
								LA class
								M 2/28
								A 7/28
								B 1/28
								C 1/28
Von Renteln et al[38], European MCT	70	45	6.9/1	27.6/8.9	12		82%	Esophagitis (42)
								LA class
								A 29.2%
								B 12.3%
Stavropoulos et al[31], Mineola, New York1	100	52 (17-93)	7.8/0.2	44.2/17.6	13.32	Mean emptying at 5 min	98%	Esophagitis
						31/42: 100% emptying		17/53 (32)
						41/42: > 50% emptying		+pH study
								17/52 (33)
Onimaru et al[39], Yokohama, Japan1	300	45 (3-87)	6.13/1.33	27.3/13.4	12		98%
Verlaan et al[40], Amsterdam, Netherlands	10	43	8/1	20.5/6.8	3	Median height	100%	Esophagitis (60%)
						1 min 3.2 cm (IQR 0.5-6.5) (P = 0.005)		LA class
						2 min 2.7 cm (IQR 0.4-5.2) (P = 0.005)		A 3/10 (30)
						5 min 2.3 cm (IQR 0-3.2) (P = 0.005)		B 3/10 (30)

¹Abstract;

²Mean;

³Median, remainder are minimum follow-up. GERD: Gastroesophageal reflux disease; LES: Lower esophageal sphincter; IQR: Interquartile range.

Table 2 Characteristics of United States single center submucosal tunneling endoscopic resection series n (%)

Characteristics	Value
STER cases (n)	7
Time period	9/2013-4/2014
Mean age (yr)	52 (47-62)
Gender	3 males: 4 females
ASA classification
II	6 (86)
III	1 (14)
Location of lesion	4 GE junction; 2 esophagus; 1 gastric cardia
General anesthesia	100%
Procedure time (min)	53 (23-80)
Closure technique	2 clips (29); 5 endoscopic suture (71)
Histopathology	6 leiomyoma (86); 1 GIST (2/50 hpf) (14)
Mean size (cm)	1.5 (1-2.7)
En bloc resection	100%
Length of hospital stay (d)	2.3 (1-4)
Follow-up	100% no recurrence
Complications	1 mucosotomy required clipping
	1 stricture at submucosal tunnel site responded to balloon dilation at 4 wk

GE: Gastroesophageal; STER: Submucosal tunneling endoscopic resection; ASA: American Society of Anesthesiologists.