Comparison between water-jet and needle for submucosal injection in peroral endoscopic myotomy for treatment of patients with achalasia ( with video ) / 中华消化内镜杂志

ABSTRACT

Objective To evaluate the efficacy and safety of submucosal injection using endoscopic water-jet in peroral endoscopic myotomy (POEM) for treatment of patients with achalasia of cardia (AC). Methods A retrospective analysis was performed on the data of 126 AC patients undergoing POEM in PLA General Hospital from March 2013 to February 2016. All the 126 patients were divided into two groups, 73 in the water-jet group and 53 in the needle injection group. The time to creating a submucosal tunnel, entire operation time, and incidence of complications were compared between the two groups. Results The time to creating a submucosal tunnel and the entire operation time of the water-jet group were both significantly less than those of the needle injection group (6. 38±0. 94 min VS 13. 81±1. 13 min, P<0. 05;27. 81±5. 76 min VS 70. 25±22. 67 min, P<0. 05). The hospital stay of patients after operation was less in the water-jet group than that in the needle injection group (4. 38±1. 87 days VS 5. 64±1. 83 days, P<0. 05). The incidence of bleeding [5. 5％ (4/73) VS 17. 0％ (9/53), P<0. 05] and fever [12. 3％ (9/73) VS 26. 4％ (14/53), P<0. 05] were lower in the water-jet group than those in the needle injection group. The incidences of perforation and pectoralgia were not significantly different between the two groups ( both P>0. 05 ) . Conclusion Endoscopic water-jet injection is safe and effective in POEM, which effectively shortens the time to creat a submucosal tunnel and the operation time, and reduces the incidences of complications including bleeding and fever.