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
ARTICLE HIGHLIGHTS
Research background

Peroral endoscopic myotomy (POEM) was first described by a study on achalasia treatment in 2010. Subsequently, it was demonstrated that POEM was effective and safe and has become the standard procedure for achalasia worldwide. However, clinical failure and adverse events of POEM have still been concerned. Indeed, POEM procedure can lead to a high incidence of reflux esophagitis.

Research motivation

Several factors are associated with the efficacy and safety of POEM, such as sufficient sub-mucosal injection, limiting mucosal injury and constructing sub-mucosal tunnel straightly. Therefore, we described a novel POEM procedure named mark-guided POEM, which may solve afore-mentioned problems.

Research objectives

This study aimed to compare the efficacy and safety of the novel mark-guided POEM with standard POEM in the improvement of efficacy and safety of achalasia treatment. This retrospective case control study will encourage us to explore the efficacy and safety of the mark-guided POEM for further research, such as multi-centers randomized controlled trials.

Research methods

This retrospective case control study compared the efficacy and safety between the mark-guided POEM and standard POEM.

Research results

This study showed that mark-guided POEM and standard POEM were both effective and safe for achalasia treatment, however, the mark-guided POEM seemed to require less procedural duration and proton pump inhibitor (PPI) use and show a lower incidence of reflux symptoms. However, these results will be confirmed by randomized controlled trials.

Research conclusions

POEM is a promising therapeutic procedure for esophageal achalasia worldwide. However, clinical failure and adverse events of POEM have still been concerned. In order to improve efficacy and safety of achalasia treatment, we described a novel POEM procedure named the mark-guided POEM. We retrospectively compared the efficacy and safety of the mark-guided POEM with standard POEM. The results showed that the clinical success was comparable between the two groups, ranging from 92% to 98%, at 3 mo, 12 mo and 24 mo postoperatively. However, the mark-guided POEM required less procedural duration, less use of PPI and lower incidence of reflux symptoms than the standard POEM. We will conduct multi-centers randomized controlled trial to confirm these results.

Research perspectives

The mark-guided POEM may be superior to standard POEM for achalasia treatment; however, the findings need to be further confirmed using multi-centers randomized controlled trials.