| BackgroundAchalasia(AC)is a rare esophageal motility disease.The etiology is still unclear.The main features are the reduction or disappearance of esophageal body peristalsis and the lower esophageal sphincter relaxation disorder.The clinical manifestations include dysphagia,retrosternal pain,reflux and weight loss,which seriously affect the quality of life of the patient.In the past,the treatment approaches mostly focused on releasing obstruction and relieving symptoms,but they had disadvantages such as poor clinical outcomes,relatively high recurrence rate which need for repeated treatments,and large trauma.Peroral endoscopic myotomy(POEM)is an emerging endoscopic treatment technology in recent years.It has the advantages of super minimally invasive,good clinical outcomes,and fewer complications.It has gradually become the standard treatment for the treatment of achalasia.However,the length of endoscopic myotomy is still controversial.Some scholars suggest that the length of the conventional myotomy is 8-10cm.Some scholars believe that the lower esophageal sphincter(LES)and its adjacent myotomy of the site could achieve the purpose of removing the obstruction and relieving the symptoms.Because the average length of LES is about 3.6cm,and the length of Laparoscopic Heller myotomy(LHM)is generally 6cm.Over the past ten years,with the rapid development and innovation of POEM technology,many scholars have carried out a large number of animal,clinical studies and related modifications on the POEM technology.Liu-POEM is a modified POEM proposed by Bingrong Liu et al in my country,that is,it eliminates the need to establish a full tunnel for endoscopic myotomy.It has the advantages of simple operation,short operation time,and less trauma.It is currently in clinical application has been widely carried out.This study analyzes and compares the surgical indicators,efficacy,and adverse events of Liu-POEM with long myotomy and short myotomy for the treatment of AC,and further explores the relationship between the length of myotomy and the efficacy of POEM,which is the treatment of AC provide a minimally invasive,safe and effective technical method.AimThe purpose of this study was to evaluate the clinical outcomes of long myotomy or short myotomy Liu-POEM on achalasia,determine the best approach,to provide a reliable basis for the technology and related clinical data for future clinical application.MethodProspective collection of diagnosed AC patients from January 2018 to December 2020.Patients were screened according to the inclusion/exclusion criteria,and the patients enrolled in this study were randomly divided into a long myotomy group and a short myotomy group using the random number method.Record and compare the clinical characteristics,operation-related paraments and adverse events of the two groups.ResultsA total of 36 patients were enrolled in this study,including 20 patients in the long myotomy group and 16 patients in the short myotomy group.There was no significant difference between the two groups in the clinical baseline level,preoperative and postoperative Eckardt scores,follow-up time,and incidence of adverse events.However,the total operation time and myotomy time of the short myotomy group were shorter than the long myotomy group.In the long myotomy group,the average total operation time was 26.4±6.1 min,and the median myotomy time was 7.8 min.During the operation,1 patient had a mucosal perforation and was clipped with endoscopic hemostatic clip,a total of 3 patients developed subcutaneous emphysema without any special treatment and could recovered itself,3 patients were diagnosed reflux esophagitis with gastroscopy and improved after application of proton pump inhibitors.In the short myotomy group,the average total operation time was 19.6±7.5 min,and the median myotomy time was 5.5 min.Subcutaneous emphysema occurred in 1 patient who recovered without any treatment After the operation,the symptoms of all patients were significantly relieved.During an average follow-up of 20 months,there were no recurrences or serious adverse events in the two groups.ConclusionsBoth long myotomy group and short myotomy group are effective in the treatment of AC,while short myotomy is technically simpler,the operation and myotomy time is shorter. |
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