A Retrospective Analysis Of Long-term Efficacy And Safety Of Peroral Endoscopic Myotomy In Patients With Achalasia Cardia

Objective:Researches on peroral endoscopic myotomy(POEM)in patients with achalasia cardia(AC)were abundant,but long-term outcomes were rare.This study aimed to evaluate the long-term efficacy and safety of POEM in AC patients and to analyze the risk factors associated with operation inefficacy and recurrence.Methods:A retrospective study included all consecutive patients with AC who underwent POEM at our hospital between January 2011 and December 2015 was performed.A telephone or We Chat was used to understand the postoperative conditions and status of the patients.The primary outcome was a clinical effectivity(defined as an Eckardt score ≤3 at 3 months after postoperation),inefficiency(defined as an Eckardt score>3 within 3 months after postoperation)and recurrence rate(defined as an Eckardt score >3 at 3 months after postoperation,according to the time of Eckardt score>3: 3 months between 3 years,early recurrence;More than 3 years,late recurrence)up to follow-up time,the risk factors of operation inefficacy and recurrence were analyzed by univariate and multivariate analysis.Secondary outcomes included perioperative and postoperative adverse events.Results:The follow-up rate was 91.5%(86/94).After a median follow-up of 79.5 months(range,60-109),the Eckardt score significantly decreased [median Eckardt score,5 to1.4(P < 0.05)].Of 86 patients,unresponsiveness in 3,early recurrence in 5,late recurrence in 2,one was treated by POEM again in unresponsiveness,one was treated by POEM again and one was treated by pneumatic balloon dilation again in early recurrence,one was treated by POEM again in late recurrence.Operative successful rate was 100%,the clinical effectivity rate was 96.5%(83/86).The recurrence rate was 8.4%(7/83).Multivariate analysis demonstrated that the length of myotomy(OR=0.095 P=0.031)and achalasia subtype(OR=0.036 P=0.014)were significantly associated with operation inefficacy and recurrence.The occurrence rate of AEs was13.9%,mild in 5,moderate in 5,severe in 2,and none of mortality.Conclusion:The long-term outcomes showed that POEM was a highly safe and effective treatment for achalasia cardia,multivariate analysis demonstrated that the length of myotomy > 5cm is more effective than that of myotomy ≤5cm and achalasia Ⅱ is more effective than achalasia Ⅲ.