Control study of peroral endoscopic myotomy and pneumatic dilation in patients with primary achalasia

Abstract

Objective To explore the difference in short-term efficacy between peroral endoscopic myotomy (POEM) and pneumatic dilatation (PD) in achalasia patients. Methods A retrospective analysis was applied. From September 2010 to March 2015, patients with POEM or PD were enrolled and divided into POEM group (n=26) and PD group (n=40). High-resolution manometry (HRM) before and one month after treatment were compared between POEM group and PD group. Before and three months after treatment, Eckardt score and gastroesophageal reflux symptom was compared between groups (Eckardt score ≤ 3 as the standard for successful treatment). Wilcoxon signed rank test was performed for before and after treatment comparison in the same group. Mann-Whitney U test was used to compare between two groups and Fisher′s exact test was used for rate comparison. Results The successful treatment rates at one and three month after POEM group were 92.3%(24/26) and 96.2%(25/26), respectively.The successful treatment rates at one and three month after PD were 87.5%(35/40) and 75.0%(30/40). At three month after treatment, the successful treatment rate of POEM group was higher than that of PD group (Fisher′s exact test, P=0.02). At three months after treatment, the Eckardt score of POEM group was lower than that of PD group (1.35, 0 to 4.00, vs 2.73, 0 to 6.00; U=-3.921, P<0.01). By the end of three months after treatment, the rate of gastroesophageal reflux symptom of POEM group was higher than that of PD group (7/26, 26.9% vs 2/40, 5.0%; Fisher′s exact test, P=0.01). The postoperative 4 second integrated relaxation pressure (4s-IRP) and lower esophageal sphincter pressure (LESP) of POEM group were both lower than those of PD group (7.01 mmHg, 3.48 to 10.40 mmHg vs 10.11 mmHg, 5.75 to 12.91 mmHg, U=-4.541, P<0.01; 11.61 mmHg, 4.21 to 14.64 mmHg vs 17.85 mmHg, 8.39 to 24.57 mmHg, U=-6.142, P<0.01). The analysis of achalasia subtypes indicated that the efficacy of POEM was better than that of PD both in type Ⅰ and type Ⅱ. Conclusion During short-term follow-up, the efficacy of POEM was better than that of PD in achalasia patients, however there was a higher incidence of post-operative gastroesophageal reflux after POEM. Key words: Achalasia; High-resolution manometry; Pneumatic dilatation; Peroral endoscopic myotomy