There were no conversions to laparoscopy and all procedures were completed successfully. Two patients required endoscopy in the early postoperative
period: self-limited hematemesis (from a submucosal GSK2118436 chemical structure tunnel) and radiologic evidence of leakage at the mucosotomy site (repaired with placement of additional clips on postoperative day 1). Patients were routinely discharged on postoperative day one (except 4 who were discharged on day 2). The median scores for solid dysphagia among the achalasia and nutcracker patients significantly improved from 4 (all meals) preoperatively to 0 (never) at 6 months. Similarly, 10 of these patients complained of either daily or continuous chest pain. ABT-888 solubility dmso At 6 months, they reported only rare or no chest pain. One DES patient reported resolution of daily preoperative dysphagia and chest pain (follow-up 9 months). Three DES patients (follow-up 8-13 months) reported decreases in the frequency of dysphagia or chest pain (daily to occasional). One of these patients underwent two postoperative endoscopic dilations for
chest pain and dysphagia. DES patients demonstrated slow improvement in their symptoms. In contrast, the dysphagia relief among the achalasia and nutcracker patients was immediate and sustained. The senior author was the primary surgeon in the first 16 patients. Two trainees
(fellows) participated in cases 17 to 24, where they performed increasing elements of the procedure under supervision. Cases 25 to 40 PLEKHB2 were primarily performed by 1 of the 2 fellows. Hence, when the 40 consecutive procedures were divided into 5 groups of 8 patients, the first and second groups were primarily performed by the attending physician, the third group was a transition period, and the fourth and fifth groups were primarily performed by the fellow. The means (± SD) of the LOP per centimeter myotomy were as follows: 16 ± 4 minutes, 17 ± 5 minutes, 13 ± 3 minutes, 15 ± 2 minutes, and 13 ± 4 minutes. The number of inadvertent mucosotomy also decreased with increasing experience in the consecutive 5 groups: 8, 6, 4, 0, and 1 (Table 1).Figure 1 and Figure 2 depict the decreasing trend in the LOP per centimeter myotomy and the number of mucosotomy. The POEM procedure represents a focused, direct approach to a selective myotomy of the inner circular layer of the esophagus and the GEJ.11 It avoids body wall trauma and minimizes the disruption of the normal anatomical architecture of the GEJ. It may represent an advance over current medical or surgical treatments for achalasia and other spastic disorders of the LES and esophageal body.