The preliminary evaluation of peroral endoscopic myotomy via posterior wall of esophagus for cardiaachalasia

Abstract

Objective To explore the clinical efficacy and safety of peroral endoscopic myotomy （POEM） via posterior wall of esophagus for eardia achalasia （AC）. Methods The patients who were diagnosed with AC by esophageal barium meal and pull-through esophageal manometry were enrolled in this study. Pre-and postoperative dysphagia score and lower esophageal sphincter relaxation pressure （LESRP） were employed to evaluate short-term efficacy of POEM for achalasia. Operation related complications were observed to assess safety of POEM via posterior wall. Results A total of 28 patients were enrolled, of whom, 26 were treated successfully by POEM via posterior wall of esophagus, with a mean operation time of 68.8 min. The procedure was discontinued in other two patients due to severe submucosal scar at cardia. No fatal intraor postoperative complications occurred during POEM. The mean LESRP decreased by 16. 37 mm Hg after POEM. One month after POEM, the mean Eckardt dysphagia symptom score was reduced by 6.69, with a total efficiency rate of 96. 1% （25/26）. Reflux symptoms developed in 1 patient after POEM. Conclusion POEM via posterior esophageal wall could efficiently improve the clinical symptoms of dysphagia and decrease LESRP in achalasia patients, which is also safe with lower rate of postoperative complication. Key words: Cardia achalasia; Peroral endoscopic myotomy （POEM） ; Short term efficacy; Safety