Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2016; 22(42): 9419-9426
Published online Nov 14, 2016. doi: 10.3748/wjg.v22.i42.9419
Full-thickness myotomy is associated with higher rate of postoperative gastroesophageal reflux disease
Xue-Hong Wang, Yu-Yong Tan, Hong-Yi Zhu, Chen-Jie Li, De-Liang Liu
Xue-Hong Wang, Yu-Yong Tan, Hong-Yi Zhu, Chen-Jie Li, De-Liang Liu, Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Author contributions: Wang XH and Liu DL designed the study; Tan YY, Zhu HY and Li CJ acquired the clinical data; Wang XH and Liu DL analyzed the data; Wang XH, Tan YY and Liu DL wrote and revised the paper.
Supported by the Development and Reform Commission of Hunan Province, China, No. XFGTZ2014713.
Institutional review board statement: The study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University, Changsha, China.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There was no potential conflict of interest related to this study.
Data sharing statement: No additional data are available.
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:
Correspondence to: De-Liang Liu, MD, Professor, Director, Department of Gastroenterology, the Second Xiangya Hospital of Central South University, NO.139 Middle Renmin Road, Changsha 410011, Hunan Province, China.
Telephone: +86-731-85295035 Fax: +86-731-85295888
Received: June 22, 2016
Peer-review started: June 22, 2016
First decision: August 29, 2016
Revised: September 12, 2016
Accepted: October 10, 2016
Article in press: October 10, 2016
Published online: November 14, 2016

To compare long-term occurrence of gastroesophageal reflux disease (GERD) between two different types of peroral endoscopic myotomy (POEM) for achalasia.


We included all patients with achalasia who underwent POEM at our hospital from August 2011 to October 2012 and had complete GERD evaluation with ≥ 3 years of follow-up. They were divided into circular or full-thickness myotomy groups according to the depth of myotomy. Demographics, Eckardt score, manometry results, 24-h pH monitoring, and GERD symptoms were recorded and compared between the two groups.


We studied 56 patients (32 circular myotomy and 24 full-thickness myotomy) with complete GERD evaluation. There was no significant difference between the two groups in terms of treatment success (defined as Eckardt score ≤ 3), postoperative Eckardt score, mean basal lower esophageal sphincter pressure, and 4-s integrated relaxation pressure (4sIRP). Postoperative abnormal esophageal acid exposure was found in 25 patients (44.6%). A total of 13 patients (23.2%) had GERD symptoms and 12 had esophagitis (21.4%). Clinically relevant GERD (abnormal esophageal acid exposure associated with GERD symptoms and/or esophagitis) was diagnosed in 13 patients (23.2%). Multivariate analysis revealed that full-thickness myotomy and low level of postoperative 4sIRP were predictive factors for clinically relevant GERD.


Efficacy and manometry are comparable between achalasia patients treated with circular or full-thickness myotomy. But patients with full-thickness myotomy and low postoperative 4sIRP have more GERD.

Keywords: Achalasia, Gastroesophageal reflux disease, Peroral endoscopic myotomy, Circular myotomy, Full-thickness myotomy

Core tip: Gastroesophageal reflux disease (GERD) is a major concern following peroral endoscopic myotomy for achalasia. Although short-term follow-up did not show an increased rate of GERD in patients who received full-thickness myotomy compared with circular myotomy, the long-term difference is still unknown. We found that full-thickness myotomy is associated with a higher rate of clinically relevant GERD.