Safety and Effectiveness of Per Oral Endoscopic Myotomy (POEM) for Achalasia in Pakistani Population

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.