Ma RX, Zhang FX, Wang Y, Chen JY, Kang SC, Wang JW, Wang XF, Jia HM. Peroral endoscopic myotomy for achalasia: Analysis of 58 cases.
Shijie Huaren Xiaohua Zazhi 2014;
22:3095-3099. [DOI:
10.11569/wcjd.v22.i21.3095]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the safety, feasibility and clinical efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia.
METHODS: Clinical data of 58 patients with AC who underwent POEM in our department from May 2011 to June 2013 were analyzed retrospectively. Intraoperative and postoperative complications, symptoms of dysphagia (subjective symptom score and Eckardt score), height of barium (cm) at 1, 2 and 5 min, and recurrence rate and the incidence of reflux evaluated by gastrointestinal endoscopy at 3, 6, 12, and 24 mo follow-ups were analyzed.
RESULTS: All the 58 patients underwent POEM successfully. A small amount of subcutaneous emphysema was observed in only 1 case, and there were no mediastinal emphysema, pneumothorax, pneumoperitoneum or other complications. The estimated average blood loss was < 10 mL, and no serious postoperative complications such as delayed bleeding, perforation and empyema occurred. Mean comprehensive subjective symptom score decreased from 10 to 0.8 following the procedure, and there were significant differences (P < 0.01) between pre and postoperative barium height and Eckardt score. During postoperative follow-up, there appeared an improvement in the life quality of patients. Approximately 75% (43/58) of patients gained weight by an average of 3.7 kg (1-7 kg). Two patients had reflux symptoms, and endoscopy suggested esophagitis (modified Los classification LA-A in one case LA-B in the other). Esophageal 24-h pH monitoring showed that prompt esophageal acid exposure time (more than 4.5% of the time pH value < 4) was 13.4%, of which 5.7% occurred in the standing position and 26.1% in the supine position, and the symptoms in all such patients were easily controlled by the usual dosage of proton pump inhibitors (PPI). During the follow-up, two patients experienced eating choking symptoms at 3 and 6 mo, respectively, and after single endoscopic balloon dilatation (EPD), Eckardt scores became 0, and the dysphagia relieved with no reflux.
CONCLUSION: POEM is safe, minimally invasive and effective in the management of achalasia.
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