Peroral endoscopic full-thickness myotomy for severe esophageal achalasia / 中华消化内镜杂志

ABSTRACT

Objective To evaluate the efficacy and safety of peroral endoscopic full-thickness myotomy for patients with severe esophageal achalasia.Methods A total of 64 patients with severe achalasia,whose Eckardt's score ≥6,esophageal diameter ≥6 cm or with S-type esophagus,were treated by peroral endoscopic full-thickness myotomy.Data of Eckardt's score,complications,recurrence,gastroscopy and esophageal barium radiography were collected before and during periodical follow-up.Results All the 64 patients underwent peroral endoscopic myotomy (POEM) successfully,mean operation time was 55 minutes,average length of tunnel and myotomy were 14.1 cm and 10.6 cm respectively,and full-thickness myotomy was performed beyond 6 cm near esophagogastric junction.Symptoms remitted in all patients.Eckardt's score decreased significantly [pre-treatment VS post-treatment,(7.4 ± 1.5) VS (0.6 ± 0.8),P ＜ 0.001],the diameter of esophageal lumen reduced[pre-treatment VS post-treatment,(59.7 ± 13.0) mm VS (31.4 ±3.3) mm,P ＜ 0.001),and the diameter of cardia increased [pre-treatment VS post-treatment,(15.6 ± 10.1) mm VS (33.4 ± 8.9) mm,P ＜ 0.001].Complications occurred in 9.4％ (6/64) of the cases,gas-related complications was 6.3％ (4/64).Treatment success was achieved in 98.4％ cases (63/64) with a follow-up of 6 ～20 months (median 12.3 months),with no recurrence cases.Conclusion Peroral endoscopic full-thickness myotomy is an effective and safe method for severe achalasia.Long-term efficacy and complications need further assessment.