Peroral endoscopic shorter versus longer myotomy for the treatment of achalasia: a comparative retrospective study
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ORIGINAL ARTICLE
Peroral endoscopic shorter versus longer myotomy for the treatment of achalasia: a comparative retrospective study Silin Huang1 · Yutang Ren2 · Wei Peng3 · Qiaoping Gao2 · Yan Peng3 · Wei Gong1 · Xiaowei Tang3 Received: 11 September 2019 / Accepted: 14 April 2020 © The Japan Esophageal Society 2020
Abstract Introduction Peroral esophageal myotomy (POEM) is a novel endoscopic treatment for achalasia. It has gained popularity worldwide among surgeons and endoscopists, but no studies have compared peroral endoscopic short with long myotomy for achalasia. We aimed to compare the clinical efficacy and safety between peroral endoscopic shorter and longer myotomy. Methods The retrospective study enrolled 129 achalasia patients who underwent POEM from July 2011 to September 2017. Based on the myotomy length (ML), patients were divided into shorter myotomy (SM) group (ML ≤ 7 cm, n = 36) and longer myotomy (LM) group (ML > 7 cm, n = 74). Procedure-related parameters, symptom scores, adverse events and manometric data were compared between two groups. Results The mean ML was 6.0 ± 0.6 cm in SM group, and 11.5 ± 3.1 cm in LM group (p 10 cm) was applied in most studies [9–15]. The key of conventional treatments was to disrupt the smooth muscle of LES, thus we hypothesized that shorter myotomy could achieve a similar satisfactory outcome in comparison with longer myotomy. Currently, there are no available studies
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comparing treatment outcomes between shorter and longer myotomy. In this study, we compared this two myotomy methods in terms of clinical outcomes and safety.
Patients and methods Patients In this retrospective study, the prospectively enrolled patients (n = 129) who underwent POEM for achalasia from July 2011 to September 2017, at Shenzhen Hospital, Southern Medical University and Affiliated Hospital of Southwest Medical University were reviewed. The flowchart of this study is shown in Fig. 1. Achalasia was diagnosed with contrast fluoroscopy, esophagoduodenoscopy (EGD) and high-resolution manometry (HRM). The first 15 cases were excluded to eliminate the effect of learning curve. Four patients were lost in follow-up. Information on patients’ age, gender, symptoms duration, American Society of Anesthesiologists Class (ASA), Eckardt score, Chicago classification [16], LES resting pressure were collected. Data regarding to intraoperative, postoperative and follow-up outcomes between the two groups were compared and analyzed. Written informed consent was obtained from all patients before POEM procedure. This retrospective review was approved by the Institutional Review Board (NFEC-2016-186). All subjects gave written consent and all research was performed in accordance with the Declaration of Helsinki (BMJ 1991; 302: 1994).
Fig. 1 Flowchart of patients enrolled in this study. POEM, peroral endoscopic myotomy
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POEM procedure All the POEM procedures were performed by a single endoscopist (Dr. Wei Gong). Patients were fast for 24 h before POEM. POEM was perfor
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