KINH NGHIỆM BAN ĐẦU CẮT CƠ THẮT QUA ĐƯỜNG MIỆNG TRONG MÔI TRƯỜNG NƯỚC ĐIỀU TRỊ CO THẮT TÂM VỊ: BÁO CÁO 24 TRƯỜNG HỢP

Abstract

Background: Achalasia is a rare esophageal motility disorder characterized by impaired lower esophageal sphincter (LES) relaxation and aperistalsis, leading to dysphagia, regurgitation, and weight loss. Peroral endoscopic myotomy (POEM) is effective but carries risks of gas-related complications due to CO₂ insufflation. Underwater POEM (U-POEM), which replaces CO₂ with water, may mitigate these risks while maintaining efficacy. We evaluated the feasibility, safety, and short-term outcomes of U-POEM. Methods: Twenty-four consecutive patients with achalasia underwent U-POEM at Tam Anh Hospital (Ho Chi Minh City, Vietnam) between May 2024 and July 2025. Demographics, procedural details, complications, and clinical outcomes were collected. The primary outcomes were procedural success and symptom relief, assessed by the Eckardt score (0–12; higher = worse symptoms). Results: All 24 patients (10 men, 14 women) underwent successful U-POEM without conversion to surgery. The mean operative time was 88 minutes (range 60–150). Median Eckardt score improved from 6 (range 3–12) before treatment to 0 (range 0–1) at 1 month. No major bleeding or perforation occurred. One patient developed a mild pneumoperitoneum that resolved conservatively. Mean hospital stay was 1.5 days (range 1–4). Conclusion: U-POEM is feasible, safe, and effective for achalasia. Compared with standard POEM, U-POEM appears to reduce CO₂-related events without losing its effect on symptom control. Confirmation of these findings will need larger patient cohorts and longer follow-up to better define its place in routine care.