Peroral endoscopic full-thickness myotomy for severe esophageal achalasia

Abstract

Objective To evaluate the efficacy and safety of peroral endoscopic full-thickness myoto- my 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. Conchlsion Peroral endoscopic full-thickness myotomy is an effective and safe method for severe achalasia. Long-term efficacy and complications need further assessment. Key words: Esophageal achalasia; Endoscopes; Follow up; Endoscopic full-thickness myotomy