Opinion of laypersons, physicians and patients on the new method of achalasia therapy (POEM) – a questionnaire-based study
Radek Doležel Orcid.org 1, Ondřej Ryska Orcid.org 2, Jana Juhásová Orcid.org 3, Štefan Juhás Orcid.org 4, Magdalena Stefanová Orcid.org 5, Julius Špičák Orcid.org 6, Jan Martínek Orcid.org 6,7, Barbora Walterová Orcid.org 8,3
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Summary
Peroral endoscopic myotomy (POEM) is a new, true endoscopy method of esophageal achalasia therapy. POEM is basically a mini-invasive surgical procedure without any body scars. There is little information on how patients, laypersons and physicians perceive the introduction of this new method for the treatment of achalasia. Aim: To obtain opinions from patients, laypersons and physicians on the role of the new POEM method for the treatment of esophageal achalasia. Methodology: A questionnaire- based study. One hundred randomly chosen laypersons (without achalasia) were asked specific questions relating to therapy preference were they to become ill with esophageal achalasia. Before filling in the questionnaire they obtained information about the disease and its possible therapies. Similar questionnaires were distributed to 56 physicians of different specializations. Lastly, we questioned 18 achalasia patients who were treated with POEM. Results: Laypersons would prefer POEM therapy in 34% (physicians in 36%), laparoscopic myotomy (LHM) in 18% (physicians in 23%) and balloon dilatation or botulotoxin injection in 2% (physicians in 11%) of cases. The majority of laypersons (46%) and a large proportion of physicians (30%) would choose a therapy method after recommendation from their personal physician. In the case of choosing between POEM and LHM only, the majority of laypersons (41%) and physicians (52%) would prefer the POEM therapeutic approach compared to LHM (21% laypersons as well as physicians), but similarly a large proportion of laypersons (38%) and physicians (27%) would respect the recommendation of their personal physician. The main reasons for POEM therapy preference were a “speculative” lower level of invasiveness. The absence of scars was not a very important factor in choosing POEM. The main reasons for LHM preference were better establishment of the method and better knowledge of the risks and long-term results. The possibility of lower gastro-esophageal reflux was not one of the main reasons for selecting LHM therapy. All questioned actual patients who were treated using POEM method before answering would prefer POEM again. Conclusion: The majority of respondents (laypersons and physicians) would respect the recommendation of their personal physician or choose the POEM method for their prospective esophageal achalasia therapy. Although not confirmed, the main reason for POEM preference is a belief in its superior safety for the patient; the absence of scars as an advantage of POEM is not so important for the respondents.
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