Background: Per-oral endoscopic myotomy (POEM) is a highly effective and safe technique for the treatment of Achalasia cardia and has gained worldwide acceptance for its promising results. This study aims to evaluate the efficacy of the POEM technique in Indian patients with achalasia cardia.

Methods: Patients with achalasia cardia undergoing POEM between January 2017and March 2019 were prospectively analyzed and were followed up for one year. All of them had high-resolution esophageal manometry before and after the procedure. The outcomes of POEM procedures including improvement in Eckardt score, occurrence of gastroesophageal reflux disease (GERD), and periprocedural complications were compared.

Results: A total of 42 patients underwent POEM for achalasia: Type I (n=10,24%), type II (n=29,69%), and type III (n=3, 7%). The technical success rate of POEM was 98%, and clinical success, defined as Eckardt score=?3 after POEM procedure, was achieved in 38 (92%) patients. The mean age was 37.1 ± 12.3 years; males constitute 66.6% of all cases. The median duration of the disease was three years. The mean pre-POEM Eckardt score was 8.76 ± 1.86, and mean post POEM Eckardt score was 1.78± 0.74 (p<0.001). The mean lower esophageal pressure before and after POEM procedure were 39.6 ± 17.6 and 15.4 ± 7.2, respectively (p<0.001). Eight (19%) patients developed GERD, as documented by clinical and endoscopic evidence of esophagitis.

Conclusion: POEM is a an effective technique, and should be offered as a first treatment option in patients with achalasia cardia and can be safely performed in small tertiary care centers of India.