Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2020; 26(9): 973-983
Published online Mar 7, 2020. doi: 10.3748/wjg.v26.i9.973
Effect and safety of mark-guided vs standard peroral endoscopic myotomy: A retrospective case control study
De-Feng Li, Feng Xiong, Zhi-Chao Yu, Hai-Yang Zhang, Ting-Ting Liu, Yan-Hui Tian, Rui-Yue Shi, Ming-Guang Lai, Yang Song, Zheng-Lei Xu, Ding-Guo Zhang, Jun Yao, Li-Sheng Wang
De-Feng Li, Feng Xiong, Zhi-Chao Yu, Hai-Yang Zhang, Ting-Ting Liu, Yan-Hui Tian, Rui-Yue Shi, Ming-Guang Lai, Yang Song, Zheng-Lei Xu, Ding-Guo Zhang, Jun Yao, Li-Sheng Wang, Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen 518020, Guangdong Province, China
Author contributions: Wang LS and Yao J were responsible for design of the study and reviewed the manuscript. Li DF and Xiong F drafted the manuscript. Li DF, Xiong F and Yu ZC abstracted data. Liu TT, Tian YH, Shi RY, Lai MG, Song Y, Xu ZL and Zhang DG performed the POEM. Yao J and Wang LS were responsible for revising manuscript. All authors have read and approved the final manuscript.
Supported by Natural Science Foundation of Guangdong Province, No. 2018A0303100024; Shenzhen Health Planning Commission, No. SZXJ2017030.
Institutional review board statement: The research was reviewed and approved by the Institutional review board of Shenzhen Municipal People’s Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Li-Sheng Wang, MD, Doctor, Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, 1017 East Gate Road, Shenzhen 518020, Guangdong Province, China. wanglsszrmyy@163.com
Received: October 30, 2019
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
Abstract
BACKGROUND

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.

AIM

To compare the efficacy and safety of a novel mark-guided POEM with standard POEM.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Mark-guided peroral endoscopic myotomy, Standard peroral endoscopic myotomy, Achalasia, Endoscopy, Efficacy, Adverse event

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.