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

IntroductionAchalasia is an uncommon disorder of esophageal motility caused by progressive loss of functional inhibi-1 tory ganglion cells of the myenteric plexus.Progression of dysphagia is caused by the lower esophageal sphinc-2 ter's inability to relax and by inefficient peristalsis.Patients present with long-standing symptoms which include chest pain, weight loss, regurgitation, and dysphagia.Diagnosis of achalasia requires barium swallow, endoscopic examination, and high-resolution manometry.Endoscopic evaluation is necessary to exclude pseudo achalasia due to carcinoma involving gastro-3 esophageal junction.The goal of achalasia treatment is to lower the resting pressure of the LES.Different treatment modalities include pharmacologic therapy using oral nitrates, injection of botulinum toxin (BT), surgical management using laparoscopic Heller myotomy and endoscopic modalities including pneumatic balloon dilation and POEM.As no treatment so far can reverse the degeneration of ganglion cells; therefore, prolonged treatment and follow-3 up is necessary.POEM is an effective modality of management for type I & II achalasia but is a preferred 4 treatment for achalasia type III.