Published online Mar 7, 2020. doi: 10.3748/wjg.v26.i9.973
Peer-review started: October 30, 2019
First decision: December 12, 2019
Revised: January 9, 2020
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: March 7, 2020
Peroral endoscopic myotomy (POEM) is a promising therapeutic modality for esophageal achalasia worldwide. However, clinical failure and adverse events of POEM have still been concerned.
To compare the efficacy and safety of a novel mark-guided POEM with standard POEM.
A total of 133 patients with esophageal achalasia who underwent POEM from May 2013 to May 2019 were enrolled in this retrospective study. Of the 133 patients, there were 64 patients in the mark-guided POEM group and 69 patients in the standard POEM group. The clinical success, procedural duration and adverse events were compared between the two groups at 3 mo, 12 mo and 24 mo postoperatively.
Characteristic baseline was similar in the mark-guided POEM group and standard POEM group. The clinical success was comparable between the two groups, ranging from 92% to 98%, at 3 mo, 12 mo and 24 mo postoperatively (all P > 0.5). Eckart score, Gastroesophageal Reflux Disease Questionnaire score and SF-36 score were not different between the two groups after treatment (all P > 0.05). No severe adverse events occurred in the two groups. However, mark-guided POEM required shorter procedural duration, and less use of proton pump inhibitors and lower incidence of reflux symptoms than the standard POEM (all P < 0.001).
Mark-guided POEM and standard POEM were both effective and safe for the treatment of esophageal achalasia. However, the mark-guided POEM was characterized by shorter procedural duration, less use of proton pump inhibitors and lower incidence of reflux symptoms.
Core tip: Mark-guided Peroral endoscopic myotomy (POEM) can create full and large separation through sufficient sub-mucosal injection, which can improve the operative filed, decrease the incidence of bleeding, perforation and intra-procedural mucosal injury, and enhance the clinical success. By mark-guided POEM, it was not necessary to repeatedly pull out the tunnel to check the direction, thus saving the procedural time. Moreover, mark-guided POEM required less use of proton pump inhibitors and showed a lower incidence of reflux symptoms after the procedure.