Peroral endoscopic myotomy plus balloon shaping for achalasia: a preliminary study.

Background/aims: To determine the efficacy and safety of circular muscle myotomy plus balloon shaping for achalasia patients.

Methodology: Peroral endoscopic myotomy plus balloon shaping was performed in 34 patients prospectively. Treatment success, changes in manometry outcomes and in body weight before and after myotomy, complications related to the procedure and reflux symptoms after procedure were analyzed.

Results: Treatment success was achieved in 97% (33/34) of cases at three months after treatment (mean score pre- vs. post-treatment 7.68 vs 0.82; P<0.001) and treatment success rate at 6 and 12 months was 94% (31/33) and 95% (19/20) respectively. Mean lower esophageal sphincter residual pressure was 25.14 mmHg pre-treatment and 10.72 mmHg post-treatment (P<0.001), with 88% (22/25) of patients' postoperative lower esophageal sphincter pressure restored to normal. The post-treatment average body weight of 34 patients was significantly higher than before (64.56 kg vs 60.04 kg, P<0.001). The overall rate of complications related to the procedure was 14.71%. 26.47% of patients developed symptoms of gastroesophageal reflux after procedure.

Conclusions: Peroral endoscopic myotomy plus balloon shaping is an effective treatment for achalasia resulting in sustained treatment success of about 95% during a mean follow-up period of 13.3 months.