Controlled Study Of Fully Covered Anti-reflux Mental Stent And Peroral Endoscopic Myotomy For Achalasia

Objctive: Although mental stent and peroral endoscopic myotomy(POEM)for achalasia have been widely used in clinical,and the study of efficacy have been reported,but the efficacy of between two treatments compared is uncleared.A randomized controlled study design was carried out to compare the efficacy of fully covered anti-reflux mental stent and POEM for achalasia.Methods: A total of 166 patients diagnosed as achalasia were enrolled between July 2012 and September 2015 in The Military General Hospital of Beijing PLA,and the patients were 2:1 randomly divided into Mental stent group and POEM group.The data of Eckardt scores and minimum width of cardia by barium swallow before and after treatment.High-resolution manometry(HRM)classification,Ling classification,barium esophagogram grade,operative time,fasting time,hospital stays after treatment,adverse reaction and weight change,dysphagia score,reflux symptoms after treatment 6months were analyzed.P<0.05 was considered statistically significance.Result: The overall remission rates at 6 months,1 year and 2 years after treatment of Mental stent and POEM respectively was 90.3% and 94.3%,85.3% and 94.6%,78.8%and 80% respectively.There were no differences between two groups at remission rates,minimum width of cardia by barium swallow,weight change and dysphagia score at 6 months after treatment(P>0.05).But the patients after treatment has greater minimum width of cardia and lower dysphagia score compared to before treatment(p<0.05).Similar incidence of reflux symptoms at 6 months was foundbetween the Mental stent and POEM groups(17.7% VS 22.6%,P>0.05).The operative time,fasting time of Mental stent group was shorter than and POEM group(7(5)min VS64(24)min,3(2)d VS 4(2)d,p<0.05),except hospital stays after treatment.Total incidence of adverse reaction in Mental stent and POEM groups was respectively 71.7%and 58.5%(P>0.05).No correlation was found between the outcome in both groups and the different classifications(P>0.05),except that barium esophagogram grade?,grade? were better than grade? after treatment in both groups.Conciusion: 1.The efficacy of mental stent group and POEM group were no statistical difference within 2 years.2.That operative time and fasting time of mental stent group were shorter than POEM group(P<0.05).Both groups has similar total incidence of adverse reaction.3.HRM classification and Ling classification was not correlated with outcome of Mental stent group and POEM group.4.the efficacy of barium esophagogram grade?,grade? were better than grade? within 1year in both groups.