Single clips versus multi-firing clip device for closure of mucosal incisions after peroral endoscopic myotomy (POEM)

Endoscopic closure systems for perforations, fistulas, and leaks. In expert hands or in all endoscopy units?

Improvement and innovation have been ongoing in gastrointestinal (GI) endoscopy for the last few years, including highly maneuverable endoscopes, high-definition visualization, digital chromoendoscopy, and wide working channels, which allow a correct identification, catheterization, and delimitation of early neoplastic lesions. Technological innovation has also provided novel devices, both to perform treatments and prevent complications.

Efficacy of anterior versus posterior per-oral endoscopic myotomy for treating achalasia: a randomized, prospective study

BACKGROUND AND AIMS

Per-oral endoscopic myotomy (POEM) has been demonstrated to be safe and effective for treating achalasia. Two approaches-anterior myotomy and posterior myotomy-are used during POEM. However, little is known about the comparison between the 2 different approaches. The objective of the study is to compare the safety and short-term efficacy of the 2 approaches for treating achalasia.

METHODS

From October 2015 to December 2016, 63 consecutive patients with achalasia without prior treatment or sigmoid-type esophagus were prospectively recruited. They were randomly assigned to an anterior or posterior myotomy group. Clinical data about general characteristics, operative parameters, pre- and postoperative Eckardt score, esophageal manometry results, 24-hour pH test, and adverse events were recorded and compared between the 2 groups.

RESULTS

The anterior group included 31 patients and the posterior group 32 patients. All patients underwent POEM successfully, and treatment success (defined as an Eckardt score ≤3) was achieved in all patients during a mean follow-up of 15.5 months. Mean Eckardt score, lower esophageal sphincter pressure, and 4-second integrated relaxation pressure were significantly decreased (6.2 ± 1.3, 37.5 ± 6.7 mm Hg, and 27.3 ± 4.9 mm Hg vs .70 ± .70, 12.8 ± 2.8 mm Hg, and 11.1 ± 2.3 mm Hg, respectively; P < .01). There was no significant difference between the 2 groups in terms of general characteristics, treatment success, pre- and postoperative esophageal manometry, Eckardt score, and adverse events (P > .05).

CONCLUSIONS

The short-term treatment efficacy, manometry outcomes, and adverse events were comparable between the anterior and posterior myotomy groups. Large-scale studies with long-term follow-up are warranted for a more definitive conclusion. (Clinical trial registration number: ChiCTR-ICR-15007211.).