title: Effectiveness of peroral endoscopic myotomy in the treatment of achalasia: a pilot trial in Chinese Han population with a minimum of one-year follow-up.
abstract: OBJECTIVE
  To investigate the outcomes of Chinese Han patients who underwent peroral endoscopic myotomy (POEM) for achalasia.
  
  
  METHODS
  Patients undergoing POEM for achalasia at the Affiliated Drum Tower Hospital of Nanjing University Medical School were prospectively enrolled in this study, with a follow-up duration of at least one year. Their outcomes were evaluated by analyzing esophageal manometry, timed barium esophagogram and 36-Item Short Form Health Survey (SF-36), which were performed before surgery, 5 days after surgery and at the last follow-up. Patients' symptom relief was considered the primary outcome. Secondary outcomes included lower esophageal sphincter (LES) pressure, esophageal emptying, patients' quality of life (QoL) and procedure-related complications.
  
  
  RESULTS
  Eighty-seven patients were included in the study. Eckardt score after POEM was remarkably lower than the preoperative score (0.4 ± 0.7 vs 7.1 ± 2.1, P = 0.001). The preoperative LES pressure was 32.4 ± 15.3 mmHg, which was decreased to 3.8 ± 3.9 mmHg immediately after surgery. The height of the barium column at 1 min after barium swallow was significantly reduced after treatment (11.7 ± 1.2 cm vs 3.2 ± 1.6 cm, P < 0.001). The patients' QoL was also improved, as indicated by obviously increased physical and mental component summary (PCS and MCS) scores of the SF-36. Complications occurred during POEM included cutaneous emphysema, mucosal injury and pneumothorax.
  
  
  CONCLUSIONS
  POEM is an effective approach for treating achalasia, which can relieve the symptoms of achalasia by improving esophageal emptying and lowering LES pressure.
authors.affiliation: Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Ting Sheng
authors.initials: TS
authors.lastname: Ling
authors.forename: Hui Min
authors.initials: HM
authors.lastname: Guo
authors.forename: Tian
authors.initials: T
authors.lastname: Yang
authors.forename: Chun Yan
authors.initials: CY
authors.lastname: Peng
authors.forename: Xiao Ping
authors.initials: XP
authors.lastname: Zou
authors.forename: Rui Hua
authors.initials: RH
authors.lastname: Shi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001466:Barium Sulfate; D003287:Contrast Media; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D019990:Perioperative Care / Q000379:methods; D010865:Pilot Projects; D011594:Psychometrics; D011788:Quality of Life; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate
keywords: effectiveness; esophageal achalasia; lower esophageal sphincter; peroral endoscopic myotomy