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Akalazya Hastalarında Peroral Endoskopik Miyotominin Etkinliği ve Güvenliği

Year 2024, , 123 - 130, 28.03.2024
https://doi.org/10.18663/tjcl.1443948

Abstract

Amaç: Bu çalışma, akalazya tanısı almış yetişkin hastalarda POEM prosedürünün etkinlik ve komplikasyonlar açısından sonuçlarını sunmayı ve yaş, cinsiyet ve obezite gibi geleneksel risk faktörlerinin bu sonuçlar üzerindeki potansiyel etkilerini araştırmayı amaçlamaktadır.
Gereç ve Yöntemler: Ocak 2021'den Temmuz 2023'e kadar POEM prosedürü geçiren toplam 51 hasta geriye dönük olarak değerlendirildi. Ana sonlanım noktası, prosedürden iki ay sonra Eckardt skorunun 3 veya daha düşük olmasıyla belirlenen klinik başarı oranı olarak değerlendirildi. İkincil sonlanım noktaları, herhangi bir advers olay, yoğun bakım ünitesine kabul ve prosedür sonrası iki ayda reflü semptomlarının varlığı olarak değerlendirildi
Bulgular: Hastaların ortalama yaşı 49,3 ± 13,3 yıl idi ve semptomların süresi 6 ay ile 10 yıl arasında değişiyordu. Ameliyat öncesi medyan Eckardt skorları 9 idi ve 5 ile 12 arasında değişiyordu. Prosedür sonrası 2. ayda hastaların %96,1'i 3 veya daha düşük bir Eckardt skoruna sahipti, medyan 8 puanlık bir azalma ile (IQR = 6 – 8, p < 0.001). Hastaların %13,7'si advers olaylarla karşılaştı, bunların %3,9'u pnömomediastinum, %1,9'u mediastinit ve %1,9'u tünel içi kanama içeriyordu. Prosedür sonrası 2. ayda hastaların %17,6'sı reflü özofajiti sergiledi. Hiçbir hastada mortalite gözlenmedi.
Sonuçlar: POEM, akalazya için etkili, güvenli ve minimal invaziv bir tedavi olup, semptomatik rahatlama, yaşam kalitesinde iyileşme sunan ve yüksek klinik başarı oranı ile umut verici bir terapötik seçenek olarak öne çıkmaktadır. Düşük oranda gözlenen advers olaylar yönetilebilir düzeydeydi ve mortaliteye neden olmadı.

Project Number

292

References

  • Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol. 2020;115:1393-1411.
  • Sadowski DC, Ackah F, Jiang B, Svenson LW. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil. 2010;22:e256-261.
  • Vaezi MF, Felix VN, Penagini R, et al. Achalasia: from diagnosis to management. Ann N Y Acad Sci. 2016;1381:34-44.
  • Arora Z, Thota PN, Sanaka MR. Achalasia: current therapeutic options. Ther Adv Chronic Dis. 2017;8:101-108.
  • Jawaid S, Draganov PV, Yang D. Esophageal POEM: the new standard of care. Transl Gastroenterol Hepatol. 2020;5:47.
  • Dirks RC, Kohn GP, Slater B, et al. Is peroral endoscopic myotomy (POEM) more effective than pneumatic dilation and Heller myotomy? A systematic review and meta-analysis. Surg Endosc. 2021;35:1949-1962.
  • Barbieri LA, Hassan C, Rosati R, Romario UF, Correale LRepici A. Systematic review and meta-analysis: Efficacy and safety of POEM for achalasia. United European Gastroenterol J. 2015;3:325-334.
  • Queneherve L, Vauquelin B, Berger A, Coron E, Olivier R. Risk factors for clinical failure of peroral endoscopic myotomy in achalasia. Front Med (Lausanne). 2022;9:1099533.
  • Onimaru M, Inoue H, Fujiyoshi Y, et al. Long-term clinical results of per-oral endoscopic myotomy (POEM) for achalasia: First report of more than 10-year patient experience as assessed with a questionnaire-based survey. Endosc Int Open. 2021;9:E409-E416.
  • Petrov RV, Fajardo RA, Bakhos CT, Abbas AE. Peroral endoscopic myotomy: techniques and outcomes. Shanghai Chest. 2021;5.
  • American Society for Gastrointestinal Endoscopy PC, Chandrasekhara V, Desilets D, et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on peroral endoscopic myotomy. Gastrointest Endosc. 2015;81:1087-1100 e1081.
  • Ortega JA, Madureri V, Perez L. Endoscopic myotomy in the treatment of achalasia. Gastrointest Endosc. 1980;26:8-10.
  • Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265-271.
  • Costantini M, Salvador R, Costantini A. Esophageal Achalasia: Pros and Cons of the Treatment Options. World J Surg. 2022;46:1554-1560.
  • Eckardt VF, Gockel I, Bernhard G. Pneumatic dilation for achalasia: late results of a prospective follow up investigation. Gut. 2004;53:629-633.
  • Min YW, Lee JH, Min BH, Lee JH, Kim JJRhee PL. Association between gastroesophageal reflux disease after pneumatic balloon dilatation and clinical course in patients with achalasia. J Neurogastroenterol Motil. 2014;20:212-218.
  • Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009;249:45-57.
  • de Moura ETH, Jukemura J, Ribeiro IB, et al. Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial. World J Gastroenterol. 2022;28:4875-4889.
  • Facciorusso A, Singh S, Abbas Fehmi SM, Annese V, Lipham JYadlapati R. Comparative efficacy of first-line therapeutic interventions for achalasia: a systematic review and network meta-analysis. Surg Endosc. 2021;35:4305-4314.
  • Ahmed Y, Othman MO. Peroral endoscopic myotomy (POEM) for achalasia. J Thorac Dis. 2019;11:S1618-S1628.
  • Shieh TY, Chen CC, Chou CK, et al. Clinical efficacy and safety of peroral endoscopic myotomy for esophageal achalasia: A multicenter study in Taiwan. J Formos Med Assoc. 2022;121:1123-1132.
  • Leung LJ, Ma GK, Lee JK, et al. Successful Design and Implementation of a POEM Program for Achalasia in an Integrated Healthcare System. Dig Dis Sci. 2023;68:2276-2284.
  • Li QL, Wu QN, Zhang XC, et al. Outcomes of per-oral endoscopic myotomy for treatment of esophageal achalasia with a median follow-up of 49 months. Gastrointest Endosc. 2018;87:1405-1412 e1403.
  • Nabi Z, Ramchandani M, Chavan R, et al. Per-oral endoscopic myotomy for achalasia cardia: outcomes in over 400 consecutive patients. Endosc Int Open. 2017;5:E331-E339.
  • Campagna RAJ, Cirera A, Holmstrom AL, et al. Outcomes of 100 Patients More Than 4 Years After POEM for Achalasia. Ann Surg. 2021;273:1135-1140.
  • Vespa E, Pellegatta G, Chandrasekar VT, et al. Long-term outcomes of peroral endoscopic myotomy for achalasia: a systematic review and meta-analysis. Endoscopy. 2023;55:167-175.
  • Nabi Z, Ramchandani M, Chavan R, et al. Peroral endoscopic myotomy in treatment-naive achalasia patients versus prior treatment failure cases. Endoscopy. 2018;50:358-370.
  • Rai M, Woo M, Bechara R. The Canadian POEM Experience: The First 50 Patients. J Can Assoc Gastroenterol. 2021;4:110-114.
  • Lois AW, Oelschlager BK, Wright AS, Templeton AW, Flum DRFarjah F. Use and Safety of Per-Oral Endoscopic Myotomy for Achalasia in the US. JAMA Surg. 2022;157:490-497.
  • Haito-Chavez Y, Inoue H, Beard KW, et al. Comprehensive Analysis of Adverse Events Associated With Per Oral Endoscopic Myotomy in 1826 Patients: An International Multicenter Study. Am J Gastroenterol. 2017;112:1267-1276.
  • Chen WF, Li QL, Zhou PH, et al. Long-term outcomes of peroral endoscopic myotomy for achalasia in pediatric patients: a prospective, single-center study. Gastrointest Endosc. 2015;81:91-100.
  • Cai MY, Zhou PH, Yao LQ, Zhu BQ, Liang LLi QL. Thoracic CT after peroral endoscopic myotomy for the treatment of achalasia. Gastrointest Endosc. 2014;80:1046-1055.
  • Nabi Z, Reddy DN, Ramchandani M. Adverse events during and after per-oral endoscopic myotomy: prevention, diagnosis, and management. Gastrointest Endosc. 2018;87:4-17.
  • Bang YS, Park C. Anesthetic Consideration for Peroral Endoscopic Myotomy. Clin Endosc. 2019;52:549-555.
  • Lee JY, Lim CH, Kim DH, et al. Adverse Events Associated With Peroral Endoscopic Myotomy Affecting Extended Hospital Stay: A Multi-center Retrospective Study in South Korea. J Neurogastroenterol Motil. 2022;28:247-254.
  • Wang Y, Liu ZQ, Xu MD, et al. Clinical and endoscopic predictors for intraprocedural mucosal injury during per-oral endoscopic myotomy. Gastrointest Endosc. 2019;89:769-778.
  • Werner YB, von Renteln D, Noder T, et al. Early adverse events of per-oral endoscopic myotomy. Gastrointest Endosc. 2017;85:708-718 e702.
  • Schlottmann F, Luckett DJ, Fine J, Shaheen NJ, Patti MG. Laparoscopic Heller Myotomy Versus Peroral Endoscopic Myotomy (POEM) for Achalasia: A Systematic Review and Meta-analysis. Ann Surg. 2018;267:451-460.
  • Repici A, Fuccio L, Maselli R, et al. GERD after per-oral endoscopic myotomy as compared with Heller's myotomy with fundoplication: a systematic review with meta-analysis. Gastrointest Endosc. 2018;87:934-943 e918.
  • Akintoye E, Kumar N, Obaitan I, Alayo QA, Thompson CC. Peroral endoscopic myotomy: a meta-analysis. Endoscopy. 2016;48:1059-1068.
  • Oude Nijhuis RAB, Prins LI, Mostafavi N, van Etten-Jamaludin FS, Smout ABredenoord AJ. Factors Associated With Achalasia Treatment Outcomes: Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol. 2020;18:1442-1453.
  • Evensen H, Smastuen MC, Schulz A, et al. One year comprehensive prospective follow-up of achalasia patients after peroral endoscopic myotomy. Ann Med. 2021;53:2225-2233.
  • Liao Y, Xiao TY, Wu YF, et al. Endoscopic ultrasound-measured muscular thickness of the lower esophageal sphincter and long-term prognosis after peroral endoscopic myotomy for achalasia. World J Gastroenterol. 2020;26:5863-5873.
  • Pham KD, Lauritzen SS, Tjora E, et al. The outcome of primary per oral endoscopic myotomy (POEM) for treatment of achalasia: Norwegian single-center experience with long-term follow-up. Scand J Surg. 2023;112:3-10.
  • Rassoul Abu-Nuwar M, Eriksson SE, Sarici IS, et al. GERD after Peroral Endoscopic Myotomy: Assessment of Incidence and Predisposing Factors. J Am Coll Surg. 2023;236:58-70.
  • Shiwaku H, Sato H, Shimamura Y, et al. Risk factors and long-term course of gastroesophageal reflux disease after peroral endoscopic myotomy: A large-scale multicenter cohort study in Japan. Endoscopy. 2022;54:839-847.

Effectiveness and safety of peroral endoscopic myotomy in patients with achalasia

Year 2024, , 123 - 130, 28.03.2024
https://doi.org/10.18663/tjcl.1443948

Abstract

Aim: This study aimed to present the outcomes in terms of efficacy and complications of the POEM procedure in adult patients diagnosed with achalasia and to investigate the potential effects of traditional risk factors such as age, gender, and obesity on these outcomes.
Material and Methods: A total of 51 patients who underwent a POEM procedure were retrospectively evaluated from January 2021 to July 2023. The main outcome measured was the rate of clinical success, determined by achieving an Eckardt score of 3 or lower two months after the procedure. Secondary outcomes involved any adverse events, ICU admissions, and the presence of reflux symptoms at the two-month post-procedure mark.
Results: The mean age of the patients was 49.3 ± 13.3 years, and the duration of symptoms ranged between 6 months and 10 years. Preoperative median Eckardt scores were 9, ranging between 5 and 12. At the 2nd month post-procedure, 96.1% of patients had an Eckardt score of 3 or lower, with a median reduction of 8 points (IQR = 6 – 8, p < 0.001). Among the patients, 13.7% encountered adverse events, comprising 3.9% with pneumomediastinum, 1.9% with mediastinitis, and 1.9% with intra-tunnel bleeding. At the 2nd month post-procedure, 17.6% of patients exhibited reflux esophagitis. No mortality was observed in any of the patients.
Conclusion: POEM is an effective, safe, and minimally invasive treatment for achalasia that represents a promising therapeutic option, offering symptomatic relief, improved quality of life, and boasting a high clinical success rate. Although a small percentage of patients experienced adverse events, these were manageable and did not result in mortality.

Ethical Statement

The study was performed in accordance with the Declaration of Helsinki, and was approved by the Umraniye Training and Research Hospital Clinical Research Ethics Committee (Date: 10.08.2023, Decision No: 292).

Project Number

292

References

  • Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol. 2020;115:1393-1411.
  • Sadowski DC, Ackah F, Jiang B, Svenson LW. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil. 2010;22:e256-261.
  • Vaezi MF, Felix VN, Penagini R, et al. Achalasia: from diagnosis to management. Ann N Y Acad Sci. 2016;1381:34-44.
  • Arora Z, Thota PN, Sanaka MR. Achalasia: current therapeutic options. Ther Adv Chronic Dis. 2017;8:101-108.
  • Jawaid S, Draganov PV, Yang D. Esophageal POEM: the new standard of care. Transl Gastroenterol Hepatol. 2020;5:47.
  • Dirks RC, Kohn GP, Slater B, et al. Is peroral endoscopic myotomy (POEM) more effective than pneumatic dilation and Heller myotomy? A systematic review and meta-analysis. Surg Endosc. 2021;35:1949-1962.
  • Barbieri LA, Hassan C, Rosati R, Romario UF, Correale LRepici A. Systematic review and meta-analysis: Efficacy and safety of POEM for achalasia. United European Gastroenterol J. 2015;3:325-334.
  • Queneherve L, Vauquelin B, Berger A, Coron E, Olivier R. Risk factors for clinical failure of peroral endoscopic myotomy in achalasia. Front Med (Lausanne). 2022;9:1099533.
  • Onimaru M, Inoue H, Fujiyoshi Y, et al. Long-term clinical results of per-oral endoscopic myotomy (POEM) for achalasia: First report of more than 10-year patient experience as assessed with a questionnaire-based survey. Endosc Int Open. 2021;9:E409-E416.
  • Petrov RV, Fajardo RA, Bakhos CT, Abbas AE. Peroral endoscopic myotomy: techniques and outcomes. Shanghai Chest. 2021;5.
  • American Society for Gastrointestinal Endoscopy PC, Chandrasekhara V, Desilets D, et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on peroral endoscopic myotomy. Gastrointest Endosc. 2015;81:1087-1100 e1081.
  • Ortega JA, Madureri V, Perez L. Endoscopic myotomy in the treatment of achalasia. Gastrointest Endosc. 1980;26:8-10.
  • Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265-271.
  • Costantini M, Salvador R, Costantini A. Esophageal Achalasia: Pros and Cons of the Treatment Options. World J Surg. 2022;46:1554-1560.
  • Eckardt VF, Gockel I, Bernhard G. Pneumatic dilation for achalasia: late results of a prospective follow up investigation. Gut. 2004;53:629-633.
  • Min YW, Lee JH, Min BH, Lee JH, Kim JJRhee PL. Association between gastroesophageal reflux disease after pneumatic balloon dilatation and clinical course in patients with achalasia. J Neurogastroenterol Motil. 2014;20:212-218.
  • Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009;249:45-57.
  • de Moura ETH, Jukemura J, Ribeiro IB, et al. Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial. World J Gastroenterol. 2022;28:4875-4889.
  • Facciorusso A, Singh S, Abbas Fehmi SM, Annese V, Lipham JYadlapati R. Comparative efficacy of first-line therapeutic interventions for achalasia: a systematic review and network meta-analysis. Surg Endosc. 2021;35:4305-4314.
  • Ahmed Y, Othman MO. Peroral endoscopic myotomy (POEM) for achalasia. J Thorac Dis. 2019;11:S1618-S1628.
  • Shieh TY, Chen CC, Chou CK, et al. Clinical efficacy and safety of peroral endoscopic myotomy for esophageal achalasia: A multicenter study in Taiwan. J Formos Med Assoc. 2022;121:1123-1132.
  • Leung LJ, Ma GK, Lee JK, et al. Successful Design and Implementation of a POEM Program for Achalasia in an Integrated Healthcare System. Dig Dis Sci. 2023;68:2276-2284.
  • Li QL, Wu QN, Zhang XC, et al. Outcomes of per-oral endoscopic myotomy for treatment of esophageal achalasia with a median follow-up of 49 months. Gastrointest Endosc. 2018;87:1405-1412 e1403.
  • Nabi Z, Ramchandani M, Chavan R, et al. Per-oral endoscopic myotomy for achalasia cardia: outcomes in over 400 consecutive patients. Endosc Int Open. 2017;5:E331-E339.
  • Campagna RAJ, Cirera A, Holmstrom AL, et al. Outcomes of 100 Patients More Than 4 Years After POEM for Achalasia. Ann Surg. 2021;273:1135-1140.
  • Vespa E, Pellegatta G, Chandrasekar VT, et al. Long-term outcomes of peroral endoscopic myotomy for achalasia: a systematic review and meta-analysis. Endoscopy. 2023;55:167-175.
  • Nabi Z, Ramchandani M, Chavan R, et al. Peroral endoscopic myotomy in treatment-naive achalasia patients versus prior treatment failure cases. Endoscopy. 2018;50:358-370.
  • Rai M, Woo M, Bechara R. The Canadian POEM Experience: The First 50 Patients. J Can Assoc Gastroenterol. 2021;4:110-114.
  • Lois AW, Oelschlager BK, Wright AS, Templeton AW, Flum DRFarjah F. Use and Safety of Per-Oral Endoscopic Myotomy for Achalasia in the US. JAMA Surg. 2022;157:490-497.
  • Haito-Chavez Y, Inoue H, Beard KW, et al. Comprehensive Analysis of Adverse Events Associated With Per Oral Endoscopic Myotomy in 1826 Patients: An International Multicenter Study. Am J Gastroenterol. 2017;112:1267-1276.
  • Chen WF, Li QL, Zhou PH, et al. Long-term outcomes of peroral endoscopic myotomy for achalasia in pediatric patients: a prospective, single-center study. Gastrointest Endosc. 2015;81:91-100.
  • Cai MY, Zhou PH, Yao LQ, Zhu BQ, Liang LLi QL. Thoracic CT after peroral endoscopic myotomy for the treatment of achalasia. Gastrointest Endosc. 2014;80:1046-1055.
  • Nabi Z, Reddy DN, Ramchandani M. Adverse events during and after per-oral endoscopic myotomy: prevention, diagnosis, and management. Gastrointest Endosc. 2018;87:4-17.
  • Bang YS, Park C. Anesthetic Consideration for Peroral Endoscopic Myotomy. Clin Endosc. 2019;52:549-555.
  • Lee JY, Lim CH, Kim DH, et al. Adverse Events Associated With Peroral Endoscopic Myotomy Affecting Extended Hospital Stay: A Multi-center Retrospective Study in South Korea. J Neurogastroenterol Motil. 2022;28:247-254.
  • Wang Y, Liu ZQ, Xu MD, et al. Clinical and endoscopic predictors for intraprocedural mucosal injury during per-oral endoscopic myotomy. Gastrointest Endosc. 2019;89:769-778.
  • Werner YB, von Renteln D, Noder T, et al. Early adverse events of per-oral endoscopic myotomy. Gastrointest Endosc. 2017;85:708-718 e702.
  • Schlottmann F, Luckett DJ, Fine J, Shaheen NJ, Patti MG. Laparoscopic Heller Myotomy Versus Peroral Endoscopic Myotomy (POEM) for Achalasia: A Systematic Review and Meta-analysis. Ann Surg. 2018;267:451-460.
  • Repici A, Fuccio L, Maselli R, et al. GERD after per-oral endoscopic myotomy as compared with Heller's myotomy with fundoplication: a systematic review with meta-analysis. Gastrointest Endosc. 2018;87:934-943 e918.
  • Akintoye E, Kumar N, Obaitan I, Alayo QA, Thompson CC. Peroral endoscopic myotomy: a meta-analysis. Endoscopy. 2016;48:1059-1068.
  • Oude Nijhuis RAB, Prins LI, Mostafavi N, van Etten-Jamaludin FS, Smout ABredenoord AJ. Factors Associated With Achalasia Treatment Outcomes: Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol. 2020;18:1442-1453.
  • Evensen H, Smastuen MC, Schulz A, et al. One year comprehensive prospective follow-up of achalasia patients after peroral endoscopic myotomy. Ann Med. 2021;53:2225-2233.
  • Liao Y, Xiao TY, Wu YF, et al. Endoscopic ultrasound-measured muscular thickness of the lower esophageal sphincter and long-term prognosis after peroral endoscopic myotomy for achalasia. World J Gastroenterol. 2020;26:5863-5873.
  • Pham KD, Lauritzen SS, Tjora E, et al. The outcome of primary per oral endoscopic myotomy (POEM) for treatment of achalasia: Norwegian single-center experience with long-term follow-up. Scand J Surg. 2023;112:3-10.
  • Rassoul Abu-Nuwar M, Eriksson SE, Sarici IS, et al. GERD after Peroral Endoscopic Myotomy: Assessment of Incidence and Predisposing Factors. J Am Coll Surg. 2023;236:58-70.
  • Shiwaku H, Sato H, Shimamura Y, et al. Risk factors and long-term course of gastroesophageal reflux disease after peroral endoscopic myotomy: A large-scale multicenter cohort study in Japan. Endoscopy. 2022;54:839-847.
There are 46 citations in total.

Details

Primary Language Turkish
Subjects Gastroenterology and Hepatology
Journal Section Research Article
Authors

Nermin Mutlu Bilgiç 0000-0003-0486-1767

Zuhal Çalışkan 0000-0001-7703-3714

Oğuzhan Öztürk 0000-0002-7718-8684

Mehmet Ali Saruhan 0000-0002-6829-1305

Kamil Ozdil 0000-0003-2556-3064

Project Number 292
Publication Date March 28, 2024
Submission Date February 27, 2024
Acceptance Date March 18, 2024
Published in Issue Year 2024

Cite

APA Mutlu Bilgiç, N., Çalışkan, Z., Öztürk, O., Saruhan, M. A., et al. (2024). Effectiveness and safety of peroral endoscopic myotomy in patients with achalasia. Turkish Journal of Clinics and Laboratory, 15(1), 123-130. https://doi.org/10.18663/tjcl.1443948
AMA Mutlu Bilgiç N, Çalışkan Z, Öztürk O, Saruhan MA, Ozdil K. Effectiveness and safety of peroral endoscopic myotomy in patients with achalasia. TJCL. March 2024;15(1):123-130. doi:10.18663/tjcl.1443948
Chicago Mutlu Bilgiç, Nermin, Zuhal Çalışkan, Oğuzhan Öztürk, Mehmet Ali Saruhan, and Kamil Ozdil. “Effectiveness and Safety of Peroral Endoscopic Myotomy in Patients With Achalasia”. Turkish Journal of Clinics and Laboratory 15, no. 1 (March 2024): 123-30. https://doi.org/10.18663/tjcl.1443948.
EndNote Mutlu Bilgiç N, Çalışkan Z, Öztürk O, Saruhan MA, Ozdil K (March 1, 2024) Effectiveness and safety of peroral endoscopic myotomy in patients with achalasia. Turkish Journal of Clinics and Laboratory 15 1 123–130.
IEEE N. Mutlu Bilgiç, Z. Çalışkan, O. Öztürk, M. A. Saruhan, and K. Ozdil, “Effectiveness and safety of peroral endoscopic myotomy in patients with achalasia”, TJCL, vol. 15, no. 1, pp. 123–130, 2024, doi: 10.18663/tjcl.1443948.
ISNAD Mutlu Bilgiç, Nermin et al. “Effectiveness and Safety of Peroral Endoscopic Myotomy in Patients With Achalasia”. Turkish Journal of Clinics and Laboratory 15/1 (March 2024), 123-130. https://doi.org/10.18663/tjcl.1443948.
JAMA Mutlu Bilgiç N, Çalışkan Z, Öztürk O, Saruhan MA, Ozdil K. Effectiveness and safety of peroral endoscopic myotomy in patients with achalasia. TJCL. 2024;15:123–130.
MLA Mutlu Bilgiç, Nermin et al. “Effectiveness and Safety of Peroral Endoscopic Myotomy in Patients With Achalasia”. Turkish Journal of Clinics and Laboratory, vol. 15, no. 1, 2024, pp. 123-30, doi:10.18663/tjcl.1443948.
Vancouver Mutlu Bilgiç N, Çalışkan Z, Öztürk O, Saruhan MA, Ozdil K. Effectiveness and safety of peroral endoscopic myotomy in patients with achalasia. TJCL. 2024;15(1):123-30.


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