Peroral endoscopic myotomy (POEM) is a new procedure for doing myotomy in patients diagnosed with

achalasia. POEM has been started at Lahore General Hospital, Lahore for the first time in the country and the aim of the

study is to assess the safety and effectiveness of the first 50 POEM procedures.

All the patients of achalasia undergoing POEM from March 13th 2020 to June 8th 2022 at Lahore General

Hospital, Lahore were enrolled. The primary outcome of the procedure was technical and clinical success. Clinical success

was defined as post-POEM Eckardt score of ≤3 at 90 days and complete clearance of contrast on post-POEM gastrograffin

study. Secondary outcomes were pre and post-POEM integrated relaxation pressure (IRP), length of myotomy, procedure

duration, rate of symptomatic GERD requiring pharmacological treatment, duration of hospital stay and adverse event rate.

Fifty patients underwent the POEM procedure. In two patients, the procedure was completed in second attempt

(technical success rate 96%). One patient did not return for follow-up. 49 patients were included for final analysis. Clinical

success defined as post-POEM Eckardt scores of ≤3 at ≥ 90 days was achieved in 46 out of 49 (93.33%) patients while the

post-POEM gastrograffin study demonstrated complete clearance of contrast in 47 out of 49 (96%) patients. The median

hospital stay after POEM was 2 days. There were no major adverse events. Symptomatic GERD post-POEM was

documented in 12 out of 49 (24.49%) patients.

POEM is a safe and effective procedure for the treatment of achalasia in the Pakistani population.