Type III is the least common occurring in approximately 10% of patients with achalasia. In this subtype, there is rapidly propagating pressurization attributable to spastic

contractions. These patients have a functional obstruction not only encompassing the esophagogastric junction but also the distal smooth muscle segment of the oesophagus. Although transabdominal LHM is the current gold standard management of type III achalasia, POEM is conceivably a more optimal therapy as it allows for a longer myotomy. Aims: To compare the efficacy and safety of POEM and LHM for the treatment click here of patients with type III achalasia. Methods: Patients who underwent POEM for treatment of type III achalasia from nine US, European and Asian centers between 2011 and 2013 were compared to a retrospective cohort of patients who had undergone transabdominal LHM between 2000 to 2013 at a single tertiary institution. Diagnosis was based on clinical presentation, manometry and barium swallow. Endoscopic and surgical procedural data were abstracted and pre- and post-procedural symptoms (e.g. Eckardt stage) were recorded. Clinical response was defined by improvement of symptoms

and decrease in Eckardt stage (reported for POEM and LHM patients) to ≤ I. (equal to an Eckardt score of ≤3). Adverse events were graded according to the ASGE lexicon’s severity grading system. Results: A see more total of 49 patients with type III achalasia underwent POEM whilst 26 underwent LHM. There was no difference between the groups with regards to age (58 vs. 52 years, p = 0.15) or gender (female 41% vs. 50%, p = 0.45).The HM cohort had a significantly higher number of patients with a pre-procedure Eckardt symptom stage of III, p < 0.01. There was no significant

difference between their pre-therapy manometry findings. Clinical response was significantly more common in the POEM group (98% vs. 85%, p = 0.04). Patients who underwent POEM had a longer mean myotomy length (16 cm vs. 8 cm, p < 0.01). Despite this, the procedure time for POEM medchemexpress was significantly shorter than LHM (102 vs. 264 min, p < 0.01).The rate of mild complications was similar between POEM and LHM (4 vs. 4%, p = 1) though moderate complications occurred more commonly in the LHM group (23% vs. 2%, p = 0.01). There was no significant difference in the mean length of stay (3.3 vs. 3.2 days, p = 0.68) between the two groups. Conclusions: This is the first study comparing the efficacy and safety of POEM and LHM for the treatment of type III achalasia. Our results suggest that POEM allows for a longer length of myotomy which may have contributed to the greater clinical response. The rate of clinically significant complications was lower in the POEM cohort.