Comparison Of The Value Of Different Kinds Of POEM In The Treatment Of Achalasia

BackgroundAchalasia(AC),also known as cardiac spasm or megaesophagus,is a kind of esophageal dyskinesia disease with unknown etiology,it is caused by increased tension and abnormal relaxation of the lower esophageal sphincter(LES),the main manifestations are dysphagia,reflux,chest pain and weight loss.Traditional treatments have some disadvantages such as poor curative effect,high recurrence rate and large trauma,peroral endoscopic myotomy(POEM)is an emerging endoscopic treatment technique that cuts the muscular layer through a submucosal tunnel,thereby reducing the pressure of LES and relieving the clinical symptoms of patients.Due to its good efficacy and safety,POEM has been widely carried out worldwide since its inception and has become the first-line treatment for AC.In recent years,with the rapid development and continuous innovation of endoscopy technology,many scholars have made a lot of attempts and improvements on the operation method of POEM.The key step in POEM is to establish a tunnel between the mucosal and muscular layers of the esophagus,and cut the muscle layer of the esophagus in the tunnel.Therefore,according to tunnel classification,POEM can be divided into four types,including traditional POEM(full tunnel),Liu-POEM and simplified POEM(short tunnel)and O-POEM(no tunnel).There are currently few reports on the comparison of traditional POEM,Liu-POEM,simplified POEM and O-POEM.This study analyzes and compares the value of these four kinds of POEM in the treatment of AC,so as to promote the further development and improvement of POEM and provide a variety of options for the treatment of AC.ObjectiveTo compare the efficacy,operation time and complications of traditional POEM,Liu-POEM,simplified POEM and O-POEM in the treatment of achalasia.MethodsThe data of 223 patients with achalasia who received POEM in the Department of Gastroenterology,the First Affiliated Hospital of Zhengzhou University and were regularly followed up from January 2015 to September 2018 were retrospectively analyzed,including 100 cases of traditional POEM,60 cases of Liu-POEM,60 cases of simplified POEM and 3 cases of O-POEM.The preoperative and postoperative symptom score(Eckardt score),operation time,complications and recurrence of four kinds of POEM were compared.ResultsThe effective rates of traditional POEM,Liu-POEM,simplified POEM and O-POEM were all 100%.The mean Eckardt scores of the four kinds of POEM were less than or equal to 3 at the 1st,6th and 12th month after operation,which were significantly lower than those before operation,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the mean Eckardt scores between the traditional POEM,Liu-POEM and simplified POEM before and after operation(P>0.05).The mean operation time and the incidence of subcutaneous emphysema of Liu-POEM and simplified POEM were lower than those of traditional POEM,the differences were statistically significant(P<0.05).The mean operation time of O-POEM was the shortest and there was no subcutaneous emphysema.There was no recurrence in all patients.ConclusionTraditional POEM,Liu-POEM,simplified POEM and O-POEM all have good efficacy in the treatment of achalasia.Compared with traditional POEM,Liu-POEM and simplified POEM have the advantages of simpler operation,shorter operation time and lower incidence of complications.O-POEM can be considered as a remedial treatment for patients who can't establish submucosal tunnel due to submucosal adhesion caused by previous treatments.