Peroral endoscopic myotomy for achalasia patients with and without prior endoscopic or surgical therapy

Abstract

Objective To explore the clinical efficacy and safety of peroral endoscopic myotomy(POEM) for achalasia(AC) with or without prior endoscopic or surgical procedures. Methods The clinical data of 164 patients with severe achalasia who were admitted to our hospital from October 2011 to April 2014 were retrospectively analyzed. They were assigned to the retreatment group and the initial treatment group. The perioperative clinical data and Eckwardt scores before and after the operation were compared. Results A total of 164 patients were enrolled, 58 of whom already received prior endoscopic or surgical procedures for therapy were in the retreatment group, and the other 106 patients of whom hadn't any treatment for achalasia were in the initial treatment group. The success rates of POEM in two groups were 94.8%(55/58) and 98.1%(104/106) , with no significant difference (P>0.05). Median follow-up time was 17 months (ranging 6-30) , and the symptoms of patients relieved after treatment. The Eckardt scores at 1, 12 and 24 months after the operation were ≤3, which were lower than that before operation(4-11). During follow-up time, one recurrence happened in each group, and symptom relief rate was 98.7%(157/159). The operation time , hospital stay and number of Hemostatic clips in the retreatment group was more than that of initial group , (70.8±20.7)min VS(68.3±27.1) min, (7.7±1.9)day VS (7.5±2.6)day, (13.0±5.7)piece VS (12.7±5.6)piece, respectively, with no significant difference (P>0.05). The incidence of complications of the retreatment group and initial group were 9.1%(5/55) and 8.7%(9/104), with no significant difference (P=0.93). Conclusion POEM is an effective and safe method for the AC who have previous endoscopic or surgical treatment. Key words: Safety; Clinical outcome; Achalasia; Peroral endoscopic myotomy