POEM is the first line of treatment for patients with esophageal achalasia, but the development of postoperative GERD remains an actual problem today. To prevent the development of reflux, we modified the conventional technique of peroral endoscopic myotomy which is that we  preservation of the sliding fibers of the stomach and the length of the esophageal myotomy.

32 patients with achalasia were included in the study. The studied group consisted of 16 men (50.0%) and 16 women (50.0%), the average age was 47.72±2.88 (95%-CI 41.95-53.49) years, the average duration of the disease was 4.33±1.07 (95%-CI 2.18-6.47) years. All patients were operated on by the modified method of peroral endoscopy myotomy with preservation of sliding fibers and minimizing length of esophageal myotomy.  To diagnose postoperative reflux, we used daily esophageal impedance-24pH monitoring and the GerdQ questionnaire (GastroEsophageal Reflux Disease Questionnaire). The effectiveness of treatment results was assessed using the Eckard symptom scale. Assessment of quality of the life parameters (questionnaires ASQ, QLQ-C30 and QLQ-OES18) and the effectiveness of the performed modified peroral endoscopic myotomy of the esophagus.

All patients of the study group were operated on by a modified method of oral endoscopic myotomy (POEM). Esophageal myotomy was performed along the back wall, the length of the myotomy was 6-8 cm, and the crossing of the LES with preservation of the sliding fibers was mandatory. The result of the operation was evaluated 3 months after the operation.

According to the assessment of 24-hour pH-metry, based on the quantitative assessment of intraesophageal pH, the performance of POEM is associated with less pronounced manifestations of reflux, although the total time of residence of pH < 4 in this group was implausibly greater than the norm. At that time, the overall average score according to the GerdQ questionnaire in the studied group was 0.78±0.25 (range 0.28-1.29). The obtained results indicate a low severity of GERD symptoms in patients 3 months after modified POEM, which confirms the effectiveness of the procedure in reducing the manifestations of reflux pathology and improving the quality of life of patients.

Modified peroral endoscopic myotomy is an effective minimally invasive endoscopic method of treating patients with esophageal achalasia, with a significantly reduced development of reflux disease. The dynamics of changes in quality of  the life indicators in patients with achalasia of the cardia 3 months after modified peroral endoscopic myotomy according to the Eckard symptom scales, achalasia-DS QoL (ASQ), EORTC QLQ-C30, EORTC QLQ-OES18 indicate a low percentage of reflux, a statistically reliable positive trend of improvement in quality of life parameters and work capacity