title: Two-year follow-up for 45 patients with achalasia who underwent peroral endoscopic myotomy.
abstract: OBJECTIVE
  Achalasia is an oesophageal disorder characterized by abnormalities of peristalsis and impaired swallowing-induced relaxation. The therapeutic approach at present remains palliative. Peroral endoscopic myotomy (POEM) is thought to be less invasive and to maintain the function of the lower oesophageal sphincter postoperatively. However, the effects of POEM still need to be evaluated and understood.
  
  
  METHODS
  We analysed the outcome for 45 achalasia patients who underwent POEM in our centre, described the details of surgery and evaluated the effects by 4 s integrated relaxation pressure (4s-IRP). All patients were followed up for at least 2 years and were assessed by the dysphagia score, the Eckardt score, oesophageal manometry and the gastro-oesophageal reflux disease (GERD) Q-questionnaire. According to the new Chicago classification of oesophageal motility using high-resolution manometry, the patients were diagnosed and classified into types I, II and III.
  
  
  RESULTS
  The average age of the patients was 46.32 ± 19.04 years (range 26-72 years), and the ratio of women to men was 1.81. All patients were suffering from dysphagia; more than half of them experienced regurgitation. The data revealed that POEM considerably reduced the 4s-IRP, dysphagia score and Eckardt score postoperatively (all P < 0.05). The patients with type III achalasia had higher values of 4s-IRP than the others (type I, P = 0.025; type II, P = 0.022) before treatment and at 3 months after treatment (type I, P = 0.028; type II, P = 0.047). In type I patients, GERD symptoms were more likely to appear at 24 months after POEM than in type II and III patients (P = 0.001 and P < 0.001, respectively).
  
  
  CONCLUSIONS
  Peroral endoscopic myotomy provides definite relief of symptoms in these patients with achalasia and offers them long-term therapeutic benefit. Considering the risks of surgery, we believe that POEM is a better choice than surgery for achalasia patients and carries lower risk. However, our study is a preliminary exploration; therefore, larger-scale studies are needed for further research on POEM.
authors.affiliation: The Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Digestive Endoscopy Institute, Nanjing Medical University, Nanjing, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Chen
authors.affiliation: The Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Digestive Endoscopy Institute, Nanjing Medical University, Nanjing, China.
authors.forename: Quan-Peng
authors.initials: QP
authors.lastname: Li
authors.affiliation: The Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Digestive Endoscopy Institute, Nanjing Medical University, Nanjing, China.
authors.forename: Guo-Zhong
authors.initials: GZ
authors.lastname: Ji
authors.affiliation: The Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Digestive Endoscopy Institute, Nanjing Medical University, Nanjing, China.
authors.forename: Xian-Xiu
authors.initials: XX
authors.lastname: Ge
authors.affiliation: The Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Digestive Endoscopy Institute, Nanjing Medical University, Nanjing, China.
authors.forename: Xiu-Hua
authors.initials: XH
authors.lastname: Zhang
authors.affiliation: The Digestive Department, Lishui County People's Hospital, Nanjing, Jiangsu, China.
authors.forename: Xiang-Yang
authors.initials: XY
authors.lastname: Zhao
authors.affiliation: The Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Digestive Endoscopy Institute, Nanjing Medical University, Nanjing, China zhanghaoran010115@aliyun.com.
authors.forename: Lin
authors.initials: L
authors.lastname: Miao
mesh_terms: D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology / Q000601:surgery*; D004945:Esophagoscopy / 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 / Q000379:methods*; D011312:Pressure; D013997:Time Factors; D016896:Treatment Outcome
keywords: Achalasia; High-resolution manometry; Integrated relaxation pressure; Peroral endoscopic myotomy