Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Senior Consultant Bengt Håkanson, Ersta Hospital, Sweden
- Second opponent: Senior Consultant Christian Rushfeldt, University Hospital of North-Norway, Tromsø
- Third member and chair of the evaluation committee: Professor Kristin Bjørnland, University of Oslo
Chair of the Defence
Professor Lars Aabakken, University of Oslo
Principal Supervisor
Professor Asle W. Medhus, University of Oslo
Summary
Peroral endoscopic myotomy (POEM) constitutes a new, mini-invasive and scarless treatment modality in achalasia, which is a chronic disease characterized by severe swallowing difficulties due to loss of normal esophageal peristalsis and sphincter relaxation. As preliminary results have been excellent, POEM has drawn a lot of attention and been proposed as a new first-line treatment option in achalasia. However, a majority of POEM studies have limited their follow-up to short-term symptom evaluation of the patients. Hence, to improve documentation of POEM in achalasia, a standardized and more comprehensive patient evaluation is warranted.
In his thesis Peroral endoscopic myotomy: Results and outcome evaluation, Helge Evensen has applied a standardized follow-up protocol for achalasia patients undergoing POEM, including extensive patient reported outcomes and objective measurements.
Evensen and his group confirmed excellent symptomatic effect of POEM in achalasia with a success rate >90% in patients three months after POEM. However, treatment effect decreased during follow-up, and reflux oesophagitis was observed in nearly 50% of the patients at one-year control.
They found that a standardized follow-up and an outcome evaluation beyond symptom score can contribute in follow-up evaluation and decision-making by providing valuable objective data and additional information from the patients’ point of view. New technology offering distensibility assessment at LES-level, may further aid follow-up evaluation and be particularily valuable in challenging clinical cases.
The main message of the thesis is that POEM is an effective treatment in achalasia. Long-term follow-up and assessment after POEM is important. Evaluation of treatment effect in achalasia is complex and should include both patient reported outcomes and objective measurements.
Additional information
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