Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2015; 21(18): 5622-5629
Published online May 14, 2015. doi: 10.3748/wjg.v21.i18.5622
Effect of peroral esophageal myotomy for achalasia treatment: A Chinese study
Bin Lu, Meng Li, Yue Hu, Yi Xu, Shuo Zhang, Li-Jun Cai
Bin Lu, Meng Li, Yue Hu, Yi Xu, Shuo Zhang, Li-Jun Cai, Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
Author contributions: Lu B designed and supervised the study; Li M, Hu Y, Xu Y, Zhang S and Cai LJ conducted the survey; Hu Y analyzed and interpreted the data and wrote the manuscript; all the authors read and approved the final version for publication.
Ethics approval: The study was reviewed and approved by the First Affiliated Hospital of Zhejiang Chinese Medical University Institutional Review Board.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest: The authors declare no financial or personal relationships with other people or organizations.
Data sharing: Technical appendix, statistical code and datasets are available from the corresponding author (lvbin@medmail.com.cn). Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bin Lu, MD, PhD, Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou 310006, Zhejiang Province, China. lvbin@medmail.com.cn
Telephone: +86-571-87032028 Fax: +86-571-87077785
Received: November 29, 2014
Peer-review started: November 29, 2014
First decision: December 26, 2014
Revised: January 15, 2015
Accepted: February 12, 2015
Article in press: February 13, 2015
Published online: May 14, 2015
Processing time: 170 Days and 3.2 Hours
Abstract

AIM: To assess the safety and feasibility of peroral esophageal myotomy (POEM) in patients with achalasia.

METHODS: From January 2012 to March 2014, 50 patients (28 men, 22 women; mean age: 42.8 years, range: 14-70 years) underwent POEM. Pre- and postoperative symptoms were quantified using the Eckardt scoring system. Barium swallow and esophagogastroscopy were performed before and after POEM, respectively. Esophageal motility was evaluated in all patients, both preoperatively and one month after POEM treatment, using a high-resolution manometry system. Manometry data, Eckardt scores, lower esophageal sphincter pressure and barium swallow results were used to evaluate the effect of the procedure.

RESULTS: POEM was successfully completed for all patients. The mean procedure time was 55.4 ± 17.3 min and the mean total length of myotomy of the circular esophagus was 10.5 ± 2.6 cm. No specific complications occurred, with the exception of two patients that developed asymptomatic pneumomediastinum and subcutaneous emphysema. Clinical improvement in symptoms was achieved in all patients. Approximately 77.5% of patients experienced weight gain 6 mo after POEM, with an average of 4.78 kg (range: 2-15 kg). The lower esophageal sphincter resting pressure, four second integrated relaxation pressure and Eckardt scores were all significantly reduced after POEM (Ps < 0.05). A small segment of proximal esophageal peristalsis appeared postoperatively in two patients, but without normal esophageal peristalsis. The average diameter of the esophageal lumen decreased significantly from 4.39 to 3.09 cm (P < 0.01).

CONCLUSION: POEM can relieve achalasia symptoms, improve gastroesophageal junction relaxation and restore esophageal body motility function, but not normal esophageal peristalsis.

Keywords: Achalasia; High-resolution manometry; Peroral endoscopic myotomy

Core tip: This clinical study describes the successful use peroral esophageal myotomy to treat achalasia patients. The efficacy of this procedure was evaluated by changes in esophageal motility, esophageal morphology and symptoms. The results show that achalasia symptoms were relieved and gastroesophageal junction relaxation and esophageal body motility function were improved up to one year after the procedure.