Abstract
Introduction In the last one decade, per oral endoscopic myotomy (POEM) has been found to be an
effective minimally invasive approach for the treatment of esophageal achalasia cardia
and was lately shown to be noninferior to laparoscopic Heller's myotomy in a randomized
controlled trial.
Here we describe a new method of using sublingual nitroglycerine spray during submucosal
tunneling to facilitate the procedure.
Materials and Methods This study includes a cohort of 50 patients who were diagnosed with achalasia cardia
on high-resolution esophageal manometry. Out of the 50 patients, 27 patients were
administered two metered doses of sublingual nitroglycerine spray during submucosal
tunneling across the gastroesophageal junction (GEJ), and 23 patients were not administered
nitroglycerine. This process was nonrandomized; patients were assigned sublingual
nitroglycerine using alternating sequence enrollment number.
Results All the procedures were technically feasible and successful without any major complications.
Eckhardt's scores of all patients normalized after the procedure. The mean submucosal
tunneling time and mean time across GEJ were 36.8 ± 7.9, 14.2 ± 2.9 in intervention
group (sublingual nitroglycerine), and 50.2 ± 8.9 and 23.0 ± 3.6 minutes in nonintervention
group, respectively. Time for each procedure was significantly less (p < 0.05) in patients who were given sublingual nitroglycerine. Mucosal injury and
bleeding during procedure were not significantly different in the two groups.
Conclusion This POEM technique with the use of sublingual nitroglycerine spray is simple and
renders POEM easier and less time consuming.
Keywords
achalasia cardia - POEM - sublingual nitroglycerine - submucosal tunneling
