| Objective:To compare and analyze the characteristics of Open peroral endoscopic myotomy(O-POEM)and Traditional peroral endoscopic myotomy in the treatment of achalasia,and to explore the safety,feasibility and short-term clinical efficacy of O-POEM.Methods:A retrospective analysis was performed on patients with achalasia who underwent endoscopic myotomy in the Department of Gastroenterology,the First Affiliated Hospital of Xiamen University from January 2014 to August 2019.Among them,20 patients were treated with O-POEM and set the O-POEM group.technical steps:① Normal saline was injected from bottom to top of the cardia.② The mucosa and submucosa were incised to 2 cm below the cardia to establish a submucosa tunnel.③ The inner and outer circular and longitudinal layers of the intrinsic esophageal muscle were incised layer by layer to preserve the integrity of the esophageal adventitia.④ Bleeding points were treated by electrocoagulation and the incision surface was checked to be free of perforation.35 patients were treated with traditional POEM and set the traditional POEM group.technical steps:①Injection of normal saline from esophagus to submucosa.② Part of the esophageal mucosa was dissected,endoscope entered and the submucosa was gradually peeled off to 2cm below the cardia to establish a submucosa tunnel.③ The inner and outer circular and longitudinal layers of the intrinsic esophageal muscle were incised layer by layer from the tunnel to 2 cm below the gastric bottom to preserve the integrity of the esophageal adventitia.④Bleeding points were treated by electrocoagulation and the tunnel was closed with titanium clip after the incision surface was checked to be free of perforation.The operation process,complication rate and recovery on the day after operation were recorded in detail and compared whether there is any difference in Eckardt score,operative time,hospitalization and postoperative complications.Results:There was no significant difference between the two groups in sex,age,disease duration,body mass index(BMI),preoperative Eckardt score,previous treatment history and Henderson grade(p>0.05).①The Eckardt score of the O-POEM group(preoperative vs 1 month postoperative)was(6.30 ± 1.34 vs 0.80 ±1.39),and the Eckardt score(preoperative vs 1 month postoperative)in the traditional POEM group was(5.57 ± 1.80 vs 0.91 ± 1.01),both groups of data were statistically significant(p<0.05).②There was no significant difference in 1 month postoperative Eckardt score(0.80±1.39 vs 0.91 ± 1.01,p=0.728)and postoperative remission rate(95%vs 94.3%,p=0.91)between the O-POEM group and the traditional POEM group(p>0.05),and the 6 month postoperative Eckardt score(1.05±1.39 vs 1.49 ±1.14,p=0.216)and postoperative remission rate(90%vs 88.6%,p=0.87)in the O-POEM group were not statistically different from those in the traditional POEM group(p>0.05).③The operative time of patients in the O-POEM group(32.85 ±16.28 vs 61.57 ± 30.34)was significantly different from that of traditional POEM group(p<0.05).④There was no significant difference in the postoperative hospitalization(4.95 ± 1.76 vs 5.51±2.06,p＝0.333)and the total incidence of postoperative complications(30%vs 25.7%,p=0.731)between the O-POEM group and the traditional POEM group(p>0.05).Conclusion:O-POEM is a feasible,safe and effective method in the treatment of esophageal achalasia.Compared with traditional POEM,the operation method is significantly simplified,the vision is clearer,the myotomy is more accurate,the operation time is significantly shorter than the traditional POEM,the gas-related complications during the operation are greatly reduced,fewer medical devices are used,and the short-term effect is satisfactory.O-POEM should be a better choice for patients with recurrent achalasia after Heller,especially for the severe submucous fibrosis of the cardia. |
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