ABSTRACT
Objective:To evaluate the efficacy and safety of peroral endoscopic myotomy (POEM) in achalasia of cardia (AC) patients with the long course.Methods:A total of 159 AC patients who received POEM from January 2015 to March 2022 in the First Affiliated Hospital of Soochow University were divided into the long course group (≥10 years) and the non-long course group (<10 years). The baseline information, POEM procedure and postoperative recurrence were compared and the differences between the recurrent patients and non-recurrent patients in the long course group were explored.Results:The age (57.09±14.30 years VS 42.08±15.68 years, t=5.569, P<0.001), the rate of treatment history [28.9% (13/45) VS 9.6% (11/114), χ2=9.319, P=0.020], the proportion of Henderson grade Ⅲ esophagus [17.8% (8/45) VS 6.1% (7/114), χ2=7.020, P=0.030] in the long course group were significantly higher than those in the non-long course group. The recurrence rate in the long course group was significantly higher than that in the non-long course group [33.3% (15/45) VS 14.9% (17/114), χ2=6.811, P=0.009]. In the long course group, the age (62.50 ± 16.94 years VS 53.77 ± 12.95 years, t=-2.121, P=0.040), and the rate of treatment history [53.3% (8/15) VS 16.7% (5/30), χ2=6.544, P=0.016] in the recurrent patients were higher than those in the non-recurrent patients. Conclusion:POEM is safe and effective for long-course AC patients. In patients with the long course, the aged patients with previous treatment are more likely to relapse.
ABSTRACT
In order to evaluate the efficacy of peroral endoscopic myotomy (POEM) for achalasia, data of 63 patients with achalasia who were treated with POEM in China-Japan Union Hospital of Jilin University from 2017 to 2021 were collected. Postoperative Eckardt score, high-resolution manometry and upper gastrointestinal radiography were compared with preoperative data. The mean age of the 63 patients was 49.0 years, and there were 31 famales. The preoperative Eckardt score was 9 (3), and the postoperative Eckardt score was 2 (2), with significant difference ( V=1 953, P<0.001). The lower esophageal sphincter pressure decreased significantly after operation compared with that before operation [9.90 (3.35) mmHg VS 26.80(13.85)mmHg, V=2 016, P<0.001]. Fifty-three patients (84.1%) had satisfactory curative effects. The incidence of adverse events was 3.2% (2/63). POEM is safe, effective and minimally invasive for the treatment of achalasia.
ABSTRACT
Objective:To explore the therapeutic effect of peroral endoscopic myotomy (POEM) for primary achalasia (AC) in patients aged over 60 years.Methods:Data of 146 patients aged ≥60 years (the elderly group) and 146 patients aged 18-59 years (the adult group) who received POEM from November 2010 to September 2019 at the Digestive Endoscopy Center of PLA General Hospital were retrospectively analyzed. Baseline data, surgery data, surgery-related complications and surgery-related efficacy were compared.Results:There was no significant difference in gender, Ling classification, HRM classification or previous treatment between the two groups ( P>0.05). All 292 patients successfully underwent POEM surgery. The clinical success (Eckardt score ≤3) rates in the elderly group and the adult group were 96.33% (105/109) and 96.77% (90/93), respectively with no significant difference between the two groups ( χ2=0.030, P>0.05). There was no significant difference in the length of myotomy between the two groups (7.09±2.49 cm VS 7.12±2.24 cm, t=0.472, P>0.05). Complications occurred in 26 cases (17.81%) in the elderly group and 21 cases (14.38%) in the adult group with no significant difference between the two groups ( χ2=0.634, P>0.05). There was no significant difference in the postoperative hospital stay (12.61±9.69 days VS 11.00±4.43 days, t=1.825, P>0.05) or the incidence of gastroesophageal reflux [43.33% (13/30) VS 51.52% (17/33), χ2=0.422, P>0.05] between the elderly group and the adult group. Conclusion:The efficacy of POEM for AC patients over 60 years old is equivalent to that of adult patients, and the incidence of complications is similar. POEM is safe and effective for AC patients over 60 years old.
ABSTRACT
Objective:To evaluate the long-term efficacy of double-tunnel peroral endoscopic myotomy (POEM) and traditional POEM in the treatment of achalasia cardia.Methods:A randomized controlled trial was performed on the data of 30 patients with achalasia cardia, who underwent POEM in the First Affiliated Hospital of Nanjing Medical University from June 2018 to June 2019. The 30 consecutive patients were randomly assigned to double-tunnel POEM group (15 cases, a second tunnel was established opposite to the traditional one) and traditional POEM group (15 cases). Intraoperative information was recorded, and patients were followed up regularly to compare the efficacy and complications between the two groups.Results:Double-tunnel POEM and traditional POEM were all completed with technical success. There were no significant differences in the intraoperative complications (5/15 VS 4/15, P=1.000), hospitalization time or cost between the two groups. The follow-up time was 17.20±4.83 months and 15.33±4.67 months in the traditional POEM group and the double-tunnel POEM group, respectively. The Eckardt scores after surgery between the two groups had no significant difference [1.53 (2.00) VS 1.60 (3.00), Z=-0.363, P=0.744]. The symptom relief cases were both 14 in the two groups. The postoperative 4-second integrated relaxation pressure (4 s IRP) of the double-tunnel group (11.27±3.14 mmHg) was significantly lower than that of the traditional group (15.05±4.21 mmHg, t=2.794, P=0.009). There was no significant difference in postoperative gastroesophageal reflux disease questionnaire scores between the two groups (4.40±1.64 VS 4.20±1.42, t=0.357, P=0.724). Conclusion:Double-tunnel POEM has almost the same efficacy as the traditional POEM except for a lower post-POEM 4 sIRP.
ABSTRACT
To investigate the effectiveness and safety of diverticular peroral endoscopic myotomy (D-POEM) for mid-esophageal diverticulum. Data of consecutive patients in the prospective database with mid-esophageal diverticulum who received D-POEM in West China Hospital, Sichuan University between April 2014 to September 2019 were collected. The modified Eckardt scoring system for mid-esophageal diverticulum was used to evaluate the severity of diverticular symptoms. The effectiveness and safety of D-POEM were evaluated in terms of clinical success, technical success, complications and recurrence. A total of 7 patients with mid-esophageal diverticulum were included. Clinical and technical success was achieved in all patients with operation time of 16-70 minutes. No serious complications (2 cases with minor complications) or recurrence occurred. The follow-up time was 2-16 months. The median modified Eckardt score decreased from 3 points before operation to 0 points after operation. It is preliminarily believed that D-POEM ensures a complete septotomy between normal esophageal lumen and esophageal diverticulum. It is a safe and effective technique for mid-esophageal diverticulum. The modified Eckardt scoring system is suitable for symptom evaluation before and after treatment of mid-esophageal diverticulum.
ABSTRACT
Objective:To evaluate the safety and efficacy of combination of submucosal tunneling endoscopic septum division (STESD) and peroral endoscopic myotomy (POEM) for the treatment of esophageal epiphrenic diverticulum with esophagogastric junction (EGJ) outflow tract disorder.Methods:From October 2017 to August 2021, 6 patients with esophageal epiphrenic diverticulum complicated with EGJ outflow tract disorder receiving combination of STESD and POEM in the Endoscopic Center of the First Affiliated Hospital of Nanjing Medical University were enrolled. The clinical characteristics of the patients were retrospectively analyzed, which included the ratio of male to female, age, course of disease, length of diverticula, location, whether with multiple diverticula, type of EGJ outflow tract disorders, whether the endoscopic technique was successful (the completion of all steps under endoscopy, including tunnel establishment and diverticulum cristae, lower esophageal sphincter and cardia muscularis propria incision); operation time, changes in the severity of clinical symptoms before and after operation (including weight loss, dysphagia, retrosternal pain, and reflux assessed using the Eckardt score), intraoperative and postoperative complications, and follow-up, including whether achieved clinical success (complete or nearly complete improvement of dysphagia, vomiting after eating, retrosternal pain, regurgitation, weight loss, no need for repeat endoscopic intervention during follow-up) and adverse events. Descriptive methods were used for statistical analysis.Results:The male to female ratio of the 6 patients was 3 to 3, the median age was 69.2 years old, and the median disease course was 92.3 months. The median length of the diverticula was 47.5 mm. Diverticulum was located in the right wall of esophagus in 4 cases and in the left wall of esophagus in 2 cases, of which 1 patient was multiple diverticulum of esophagus. Achalasia was found in 5 cases, and EGJ outflow obstruction was found in 1 case. All the 6 patients successfully completed combination of STESD and POEM, and all achieved successful edoscopic technique. The operation time (range) was 55 min (40 to 70 min). Clinical symptom Eckardt score (range) before and after operation was 9.0 (7.0 to 11.0) and 1.3 (1.0 to 2.0), respectively. After operation the clinical symptom improved compared with that before operation. There were no delayed bleeding, perforation, infection, subcutaneous emphysema and other complications and severe adverse events. Six patients were all cured and discharged. Follow-up period was 1 to 50 months. The symptoms of dysphagia, vomiting after eating, retrosternal pain, regurgitation and weight loss were all significantly improved compared with those before operation. There were no severe adverse events and all achieved clinical success.Conclusions:Combination of STESD and POEM is safe and effective in the treatment of esophageal epiphrenic diverticulum with EGJ outflow tract disorder, and has good short-term and long-term effects.
ABSTRACT
Objective:To investigate the medium- and long-term efficacy of peroral endoscopic myotomy (POEM) for esophageal diverticulum and the risk factors for postoperative recurrence.Methods:A retrospective study was conducted on 31 cases of esophageal diverticulum who were treated by POEM in Zhongda Hospital, Southeast University from May 1st 2016 to August 1st 2019. The Eckardt score, the operative success rate, and the recurrence rate after the operation were observed and recorded. Multivariate logistic regression analysis was performed to explore the risk factors for postoperative recurrence.Results:POEM was successfully completed in all 31 patients, who were followed up for 30.6±11.1 months (20-63 months). The Eckardt score before the operation was 8.2±2.4, and was 1.4±0.7, 1.4±1.1, 1.3±1.1, and 1.3±0.9 at 1, 6, 12 and 24 months, respectively after the operation, which significantly decreased at all follow-up time points ( P<0.001). The success rates at 1, 6, 12, and 24 months after the operation were 96.8% (30/31), 90.3% (28/31), 90.3% (28/31) and 90.3% (28/31), respectively. Three patients suffered symptom relapse, with an overall recurrence rate of 9.7% (3/31). Logistic regression analysis showed that the disease duration ( P=0.038, OR=1.041, 95% CI: 1.002-1.080) and preoperative Eckardt score ( P=0.024, OR=2.299, 95% CI: 1.117-4.728) were risk factors for postoperative recurrence of POEM. Conclusion:POEM is safe and effective for esophageal diverticulum. Patients with long disease duration and high preoperative Eckardt score are associated with recurrence.
ABSTRACT
Background: Peroral endoscopic myotomy (POEM) is safe and effective in the treatment of achalasia (AC). However, there are few reports on application of POEM in the elderly, and is limited by small sample size and short follow-up. Aims: To evaluate the efficacy and safety of POEM and its influential factors on AC in geriatric patients. Methods: A total of 215 AC patients received POEM from November 2012 to December 2018 at the First Affiliated Hospital of Nanjing Medical University were enrolled, and were divided into elderly group (≥60 years old) and non-elderly group (0.05). The median follow-up was 42 (29, 60) months. The rate of treatment failure or recurrence in elderly group was significantly increased than that in non-elderly group (17.5% vs. 7.4%, P=0.047). However, there was no statistical difference in incidence of clinical reflux between the two groups (P>0.05). The postoperative efficacy was correlated with preoperative IRP in elderly patients (P=0.033). The propensity score matching results showed that no significant difference in prognosis was found between the two groups. Conclusions: POEM is safe and effective for elderly patients with AC. However, the efficacy is lower in elderly patients than that in non-elderly patients due to the long course of disease and lower preoperative IRP.
ABSTRACT
Background: Achalasia patients may have reflux symptoms before and after peroral endoscopic myotomy (POEM), the mechanism is not completely consistent. Aims: To investigate the effect of POEM on reflux symptoms in patients with achalasia. Methods: Eighty-four achalasia patients underwent POEM from May 2011 to July 2018 at the First Affiliated Hospital of Nanjing Medical University were enrolled. According to whether they had reflux symptoms before or after POEM, the patients were divided into preoperative reflux group, preoperative non-reflux group or postoperative reflux group, and postoperative non-reflux group. Symptoms and parameters of high-resolution manometry before or after POEM were compared, respectively. Results: After POEM, the lower esophageal sphincter pressure (LESP), integrated relaxation pressure (IRP), Eckardt score in patients with achalasia were significantly decreased (P<0.05). Compared with preoperative non-reflux group, length of esophagus was significantly longer (P<0.001) and postoperative Eckardt score was significantly decreased (P=0.039) in preoperative reflux group. However, no significant differences in preoperative or postoperative LESP and IRP were found between the two groups. No significant differences in the incidence of preoperative reflux, postoperative LESP and IRP were found between postoperative reflux group and postoperative non-reflux group. Conclusions: The preoperative reflux symptom of achalasia patients may be caused by retention of food in esophagus. The preoperative reflux symptom may predict the better efficacy of POEM. Postoperative reflux symptom may be not correlated with LESP, but related with dysmotility of esophageal body or esophageal hypersensitivity.
ABSTRACT
Objective@#To evaluate the feasibility, safety and efficacy of repeated peroral endoscopic myotomy (Re-POEM) as a make-up therapy after POEM failure.@*Methods@#Thirty-three patients with persistent/recurrent symptoms after first POEM (Eckardt symptom score≥4) were selected from a database of a total of 2 516 consecutive patients with achalasia. The main outcome measures was Eckardt score during follow-up; the secondary outcome measures were procedure-related adverse events, changes in manometric lower esophageal sphincter (LES) pressure, and reflux symptoms before and after Re-POEM.@*Results@#All patients successfully underwent Re-POEM in mean 18.6 months (ranging 3-55 months) after their first POEM procedures. The mean symptom score before Re-POEM was 5.5 (ranging 4-8). Mean operation time was 45.1 minutes (ranging 28-64 minutes). Submucosal tunnel infection occurred in 1 patient who recovered with conservative treatment. During a mean follow-up period of 36.6 months (ranging 12-58 months), symptom relief was achieved in all patients. Eckardt score reduced to 1.3 (ranging 0-3), significantly different from that before (P<0.001). Mean LES pressure also declined from 26.0 mmHg (1 mmHg=0.133 kPa) to 9.6 mmHg after Re-POEM (P<0.001). The incidence of gastroesophageal reflux of Re-POEM was 33.3% (11/33).@*Conclusions@#Re-POEM appears safe and effective as a make-up option after POEM failure.
ABSTRACT
Objective To evaluate the safety, feasibility, perioperative and long-term efficacy of peroral endoscopic myotomy ( POEM) for achalasia ( AC) in geriatric patients. Methods Data of 41 patients aged over 65 diagnosed with achalasia and treated with POEM in Zhongshan Hospital from August 2010 to December 2014 were retrospectively studied. Perioperative complications, preoperative and postoperative Eckardt score and pressure of the lower esophageal sphincter, esophageal reflux and clinical failure were analyzed. Results All 41 patients underwent POEM successfully, with median operation time of 42 min. Median hospitalization was 3 days. Major perioperative adverse events occurred in 4 cases ( 9. 75%) , whose hospitalization was longer than 5 days for perioperative adverse events. During median follow-up period of 40 months ( interquartile range 24-57 months) , median Eckardt score decreased from 8 to 1( P<0. 001 ) and pressure of the lower esophageal sphincter decreased from 23. 85 mmHg ( 1 mmHg=0. 133 kPa) to 9. 05 mmHg (P=0. 005). Clinical reflux occurred in 12 cases (29. 27%) and the 5-year success rate of POEM was 87. 80% (36/41). Conclusion POEM is a safe and reliable treatment for geriatric AC patients with confirmed short-term and long-term effectiveness.
ABSTRACT
Objective To investigate the efficacy and safety of gastric peroral endoscopic myotomy ( G-POEM) for postsurgical gastroparesis. Methods A retrospective analysis was performed on data of 47 patients with gastroparesis after subtotal gastrectomy, who underwent G-POEM at Zhongda Hospital Southeast University form August 2016 to June 2018. G-POEM procedure, complications related to G-POEM, and improvement of symptoms and gastric emptying function were observed. Results All patients underwent G-POEM successfully. No serious G-POEM-related complications were observed. During a follow-up period of 9. 8±5. 8 months (range 3-18 months), the scores of gastroparesis cardinal symptoms index (GCSI) were 1. 6±0. 5, 1. 2±0. 4, 1. 1±0. 6, 1. 4±0. 3 and 1. 7±0. 3 respectively at the 1st, 3rd, 6th, 12th, and 18th months after G-POEM, and all scores were lower than that before G-POEM (3. 8±1. 1, all P<0. 01). The results showed the symptoms of gastroparesis were improved significantly. Gastric emptying imaging showed the hemi-emptying time was 23. 8±8. 8 min, 21. 2±9. 5 min, 20. 9±8. 3 min and 26. 4±7. 8 min at the 1st, 6th, 12th and 18th months after G-POEM, respectively, significantly shorter than that before G-POEM (67. 8±12. 5 min, all P<0. 01). Three-dimensional ultrasonography results of gastric antrum volume showed that the hemi-emptying time was 26. 4 (21. 8, 40. 3) min, 22. 6 (13. 9, 32. 7) min, 24. 3 (18. 2, 36. 5) min and 26. 8 (16. 4, 38. 5) min at the 1st, 6th, 12th and 18th months after G-POEM, respectively, which were all significantly shorter than that before G-POEM [ 72. 5 ( 48. 3, 108. 6 ) min, all P<0. 01 ] . Conclusion G-POEM has a satisfactory long-term efficacy on the treatment of gastroparesis after subtotal gastrectomy with good safety.
ABSTRACT
Peroral endoscopic myotomy (POEM) is a novel clinical technique developed in 2010, and has been widely accepted for treating achalasia and esophageal motility disorders, because of its minimal invasiveness and good efficacy. Zhongshan Hospital has published the practice guideline (the "Zhongshan experience") of peroral endoscopic myotomy of achalasia (v1.2018) based on experience combined with literatures. (1) Preoperative evaluation includes clinical symptom assessment, gastroscopy, high-resolution manometry and upper gastrointestinal radiography. (2) Absolute indication is idiopathic achalasia, and age is no longer a contraindication. (3) The criteria include the medical centers with legal qualifications and the operators with over 5 years of clinical experience in gastroenterological surgery or gastroenterology and more than 30 cases of esophageal endoscopic submucosal dissection (ESD). (4) The length of the myotomy is 8 to 10 cm. The recommended location of the myotomy is the anterior or posterior wall. Whether a full-thickness or circular muscle myotomy is chosen is based on patient′s condition. (5) If pleural effusion, atelectasis or pneumothorax occurs, CT examination is recommended during the postoperative period. If patients presents with symptoms such as vomiting and high fever, endoscopic examination and upper gastrointestinal radiography should be performed. (6) Major adverse events include mucosal injury, perforation, bleeding, pneumothorax and pleural effusion. (7) The Eckardt score system and endoscopic examination are used for evaluating the effectiveness after POEM.
ABSTRACT
A recent achalasia guideline suggests that peroral endoscopic myotomy (POEM) is a safe option for achalasia that is as effective as Heller myotomy. It is recommended that POEM should be performed under general anesthesia. The incidence of adverse events such as bleeding, perforation, and carbon dioxide insufflation-related complications was lower in POEM under endotracheal general anesthesia than in POEM under sedation. Subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum, and accompanying hemodynamic instability can be caused by carbon dioxide insufflation. Treatment of possible physiological changes and adverse events during the POEM procedure from the point of view of anesthesiologists may give endoscopists a new perspective on improving patient safety. The territory of therapeutic endoscopy can be expanded through cooperation with other departments, including anesthesia services. Efforts to understand different perspectives will certainly help not only secure patient safety but also expand the area of treatment.
Subject(s)
Anesthesia , Anesthesia, General , Carbon Dioxide , Endoscopy , Esophageal Achalasia , Hemodynamics , Hemorrhage , Incidence , Insufflation , Mediastinal Emphysema , Patient Safety , Pneumoperitoneum , Pneumothorax , Subcutaneous EmphysemaABSTRACT
BACKGROUND/AIMS: Endoluminal functional lumen imaging probe (EndoFLIP) is a modality that enables clinicians to measure volume-controlled distension of the esophagus. This study aimed to assess the utility of EndoFLIP in patients who had achalasia treated with peroral endoscopic myotomy (POEM). We hypothesized that improvement in the distensibility index (DI) is correlated with the postoperative clinical outcome of POEM. METHODS: Patients who underwent POEM for achalasia at Cha Bundang Medical Center were included. Physiological measurements of the lower esophageal sphincter (LES) pressure before and after POEM were assessed using EndoFLIP. Patients’ symptoms were recorded using the Eckardt score. RESULTS: A total of 52 patients with achalasia were included in this study. Patients with a post-POEM DI below 7 (30 or 40 mL) had a significantly higher rate of incomplete response after POEM (p=0.001). Changes in LES pressure or integrated relaxation pressure after POEM were also significantly associated with an incomplete response (p=0.026 and p=0.016, respectively). Multivariate analysis showed that post-POEM DI < 7 was the most important predictor of an incomplete response after POEM (p=0.004). CONCLUSIONS: Lower post-POEM DI values were associated with an incomplete post-POEM response. Therefore, post-POEM DI at the esophagogastric junction using EndoFLIP is a useful index for predicting the clinical outcome of POEM in patients with achalasia.
Subject(s)
Humans , Esophageal Achalasia , Esophageal Sphincter, Lower , Esophagogastric Junction , Esophagus , Multivariate Analysis , Relaxation , Treatment OutcomeABSTRACT
Background:Peroral endoscopic myotomy (POEM) has been widely used in treatment of achalasia,and the efficacy is satisfactory.However,POEM is associated with high level of technical difficulty and high incidence of complications.Aims:To investigate the efficacy and safety of Flush knife and SB knife in POEM for treatment of achalasia.Methods:A total of 111 achalasia patients who had undergone POEM from April 2013 to April 2017 at Renmin Hospital of Wuhan University were enrolled,and were divided into Flush knife group,SB knife group and Dual knife group.Procedure-related parameters,complications,and follow-up data were compared among the three groups.Results:All the 111 patients underwent POEM successfully.The mean procedure time,mean frequency of hemostasis and mean frequency of device exchange were significant different among Flush knife group,SB knife group and Dual knife group (P all < 0.05).Further comparisons showed that the above-mentioned procedure-related indices were significantly lower in Flush knife group and SB knife group than in Dual knife group (P all < 0.05).The incidence of complications was significant different among the three groups (P =0.005).Further comparisons showed that incidence of complications was significantly lower in SB knife group than in Dual knife group (P =0.011),however,no significant difference was found between Flush knife group and Dual knife group (P =0.056).No significant difference in surgery success rate was found among the three groups (P >0.05).Conclusions:Flush knife and SB knife in POEM can shorten the procedure time and achieve similar success rate when compared with conventional Dual knife.
ABSTRACT
Objective?To observe the clinical efficacy of peroral endoscopic myotomy (POEM) in treatment of achalasia of cardia (AC).?Methods?30 patients with AC were enrolled and treated with POEM from March 2013 to June 2017.?Results?All the 30 cases underwent surgery of POEM successfully. There was 3 cases of subcutaneous emphysema, 2 cases of mild sternal discomfort, 4 cases of post-operative fever and 1 case of delayed hemorrhage in the upper gastrointestinal tract. The Eckardt score (1.1 ± 0.6) was significantly lower than that before operation (5.2 ± 1.3) (P < 0.05). Postoperative BMI (22.6 ± 2.9) kg/m2 was significantly higher than preoperative (19.2 ± 1.8) kg/m2 (P < 0.05). Of the esophageal dynamic index, lower esophageal sphincter pressure (LESP) after operation (18.2 ± 9.5) mmHg was significantly lower than pre-operation (46.7 ± 15.8) mmHg (P < 0.05). Integrated relaxation pressure (IRP) after operation (10.5 ± 2.5) mmHg was significantly lower than pre-operation (22.8 ± 8.3) mmHg (P < 0.05). Length of lower esophageal sphincter (LESL) after operation (2.5 ± 0.5) cm was shorter than pre-operation (2.9 ± 0.8) cm (P < 0.05). Upper esophageal sphincter pressure (UESP) and length of upper esophageal sphincter (UESL) had no significant difference before and after operation (P > 0.05).?Conclusion?POEM is an effective treatment for AC, its short-term effect is affirmed, and its safety is relatively high, part of esophageal dynamic indexes were improved. Long-term efficacy and complications of POEM still need large sample to further follow-up.
ABSTRACT
Objective To compare the advantage and disadvantage of peroral endoscopic myotomy (POEM)and pneumatic dilation(PD)for the treatment of achalasia of cardia(AC). Methods Patients with confirmed AC undergoing endoscopic therapy in Southwest Hospital, Third Military Medical University between January 2011 and September 2014 were divided into POEM treatment group(n=56)and PD treatment group(n = 30), according to the decision of the patients and their families. Postoperative improvement of clinical symptoms, changes in the maximum esophageal diameter, complications, hospital stay,and inpatient expenses were compared between the two groups. Results No significant differences were observed in general preoperative data between the two groups,including gender,age,body mass index (BMI),maximum esophageal diameter, Eckardt score and disease duration(all P>0.05). The Eckardt score showed a significant decrease in 1, 6, and 12 months after operation compared to the pre?operation score in both groups(P<0.05). No matter 1 month or 6 months after operation, the Eckardt score had no significant difference between the two groups(P>0.05). Six months after operation, the response rate between the two groups was no significantly different[93%(52/56)VS 80%(24/30), χ2=0.115, P=0.076],but the maximum esophageal diameter of the POEM group was smaller than that of the PD group (25.39±7.12 mm VS 32.12±9.99 mm,t=3.612,P=0.001). Twelve months after operation,the Eckardt score of the POEM group was lower than that of the PD group(0.44±0.85 score VS 1.26±1.74 score,t=2.940,P= 0.004), and the response rate was higher in the POEM group[93%(52/56)VS 80%(24/30),χ2=0.115, P=0.076]. The incidence of pneumatic complications was 32%(18/56)in the POEM group,but none occurred in the PD group(χ2=12.195,P=0.000). The hospital stay of the POEM group and the PD group was 12.33±4.13 days and 6.50±2.28 days, respectively(W=616, P=0.000). The inpatient expense of the POEM group and the PD group was 8 013.283± 4 322.695 yuan, and 1 571.018±1 590.193 yuan,respectively(W=505,P=0.000).Conclusion Both POEM and PD showed good short?term efficacy for AC.POEM is more effective,and its treatment outcome lasts longer,whereas PD has more widely indications because it is easier to operate with less complications,shorter hospital stay,and lower costs.Trail registration Chinese clinical trial registry,ChiCTR?OOC?15005889.
ABSTRACT
Objective To compare the clinical efficacy and safety of Hybrid knife versus triangular tip during peroral endoscopic myotomy(POEM) for patients with achalasia of cardia. Methods Data of patients with achalasia of cardia who received POEM in Nanfang Hospital, Southern Medical University from June 2012 to July 2014 were collected and divided into the Hybrid knife group ( using Hybrid knife) and triangular tip group ( using injection needle and triangular tip). Procedure-related parameters, symptom relief, and adverse events were compared between the two groups. Results A total of 57 patients were selected, including 25 patients in the Hybrid knife group and 32 in the triangular tip group. There were no significant differences on baseline characteristics between the two groups ( P>0. 05). The mean procedure time was shorter in the Hybrid knife group than that in the triangular tip group (55. 3±17. 7 min VS 69. 5± 9. 4 min, P=0. 038). The mean frequency of devices exchange was less in the Hybrid knife group than that in the triangular tip group (4. 5±1. 5 VS 10. 7±1. 7, P=0. 000). No serious complications occurred during operation and periodical follow-up in both groups. At one-year follow-up, the treatment success rate was 92. 0%(23/25) in the Hybrid knife group and 96. 9%(31/32) in the triangular tip group (P=0. 576). Conclusion Using Hybrid knife in POEM can shorten procedural time and achieve similar treatment success rate compared to triangular tip.
ABSTRACT
Objective To compare the long-term efficacy and complications of peroral endoscopic circular myotomy and full-thickness myotomy for patients with achalasia of cardia. Methods A retrospective analysis was performed on the data of 53 patients with achalasia of cardia, who underwent peroral endoscopic myotomy in the First Affiliated Hospital of Zhengzhou University from June 2012 to December 2014 and were followed-up regularly.Twenty-one patients underwent circular myotomy, and the other 32 patients underwent full-thickness myotomy. The postoperative long-term efficacy and gastroesophageal reflux complications of the two groups were compared. Results The effective rate of the circular myotomy group and the full-thickness myotomy group was 90. 5%( 19/21) and 100. 0%( 32/32), respectively ( P= 0. 152). There were no significant differences between the two groups on postoperative Eckardt scores, lower esophageal sphincter pressure and 4 s integrated relaxation pressure ( P > 0. 05 ). The incidence of clinically relevant gastroesophageal reflux of full-thickness myotomy group was higher than that of circular myotomy group (40. 6% VS 14. 3%, χ2=4. 174, P=0. 041). Conclusion The long-term efficacy of circular myotomy is similar to that of full-thickness myotomy, but the incidence of clinically relevant gastroesophageal reflux is higher in full-thickness myotomy.