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