Short-term Outcome of Peroral Endoscopic Myotomy Performed by the Same Endoscopist on Achalasia and Nonachalasia Esophageal Motility Disorders

BACKGROUND

Peroral endoscopic myotomy (POEM) is a relatively new but increasingly therapeutic option for achalasia. In recent years, POEM has been used for nonachalasia esophageal motility disorders (NAEMDs), such as diffuse esophageal spasm, esophagogastric junction outlet obstruction, and hypercontractile disorder, with some clinical success. No studies thus far compare the outcomes of these two groups. We perform the first head-to-head comparison of outcomes after POEM in patients with achalasia and NAEMD.

PATIENTS AND METHODS

A retrospective analysis of all patients undergoing POEM at one university hospital by a single expert endoscopist from July 2021 to December 2022 was performed. All patients were symptomatic, and the presence of esophageal motility disorders was confirmed using multiple diagnostic modalities. These patients were then divided into 2 groups, achalasia and NAEMD, based on the underlying diagnosis. Statistical analysis of different clinical outcomes, including effectiveness and safety, was performed.

RESULTS

Thirty-seven patients (mean age: 59.55, females: 22) underwent POEM in the study period. Twenty patients had achalasia and 17 patients had NAEMD. The median myotomy length was 5.5 cm for the achalasia group and 10 cm for the NAEMD group. This excluded patients with esophagogastric junction outlet obstruction in which the median myotomy length was 3 cm. The procedure time, the duration of hospital stays, the rates of same-day discharge, and complications were similar between the two. Short-term outcomes of POEM for the two groups were similar with improvement in 94% of patients in the achalasia group and 93.75% in the NAEMD group.

CONCLUSION

Contrary to prior observations, our study highlights that POEM is equally effective in achieving clinical improvement in patients with NAEMD as achalasia over 6 months of follow-up. In addition, POEM has a comparable safety profile in both patient groups making it a feasible therapeutic option for these debilitating and challenging disorders.

Antihypertensive efficacy of anipamil in mild to moderate hypertension

The antihypertensive efficacy of anipamil, a novel calcium antagonist of the verapamil type, was tested in an open group comparison. One hundred twenty-one hypertensive patients (World Health Organization stage I-II) entered the study in 17 centers in Germany and Austria. After a placebo washout period patients were randomly allocated to either 40, 80, or 120 mg of anipamil for a period of 7 days. This treatment period was followed by another 7-day placebo period. Anipamil lowered systolic and diastolic blood pressure in all three dosages tested. The 80-mg dose was more effective than 40 mg. The 120-mg dose did not show an increased effect over 80 mg. Heart rate was slightly lowered, reaching statistical significance in the groups receiving 80 and 120 mg. In the dosages tested, anipamil had no effect on PQ-interval or other electrocardiogram parameters. Major or clinically relevant changes in the laboratory parameters could not be detected. Side effects were rare, mild, and transient. No patient had to be discharged from the trial due to severe side effects.