Initial Experience With Underwater Peroral Endoscopic Myotomy (U-Poem) in the Treatment of Achalasia at Tam Anh Hospital, Ho Chi Minh

Background Achalasia is an esophageal motility disorder that presents with symptoms such as dysphagia, heartburn, chest pain, and weight loss. The prevalence is approximately 10–15 per 100,000 individuals [1]. While conventional peroral endoscopic myotomy (POEM) has been successfully applied in treating this condition, using CO₂ for submucosal tunnel creation may lead to complications such as pneumomediastinum and pneumothorax [5]. Underwater POEM (U-POEM), a technique that utilizes water instead of gas, was developed to mitigate these risks [2, 5, 6]. Methods A case series study was conducted on 11 patients diagnosed with achalasia who underwent underwater peroral endoscopic myotomy (U-POEM) at Tam Anh Hospital, Ho Chi Minh City. The assessment parameters included operative time, length of hospital stay, preoperative and postoperative Eckardt scores, incidence of gastroesophageal reflux disease (GERD), and complications. Results The results demonstrated that U-POEM achieved therapeutic efficacy comparable to conventional POEM, significantly improving postoperative Eckardt scores. Gas-related complications were mild and managed conservatively. Conclusion U-POEM is a safe and effective technique for treating achalasia. Additionally, it offers technical advantages, such as reducing gas-related complications, improving visualization, minimizing thermal injury, and maintaining pressure stability. Further studies with larger sample sizes and long-term follow-up are necessary to confirm these benefits.