title: Effect of peroral esophageal myotomy for achalasia treatment: A Chinese study.
abstract: OBJECTIVE
  To assess the safety and feasibility of peroral esophageal myotomy (POEM) in patients with achalasia.
  
  
  METHODS
  From January 2012 to March 2014, 50 patients (28 men, 22 women; mean age: 42.8 years, range: 14-70 years) underwent POEM. Pre- and postoperative symptoms were quantified using the Eckardt scoring system. Barium swallow and esophagogastroscopy were performed before and after POEM, respectively. Esophageal motility was evaluated in all patients, both preoperatively and one month after POEM treatment, using a high-resolution manometry system. Manometry data, Eckardt scores, lower esophageal sphincter pressure and barium swallow results were used to evaluate the effect of the procedure.
  
  
  RESULTS
  POEM was successfully completed for all patients. The mean procedure time was 55.4 ± 17.3 min and the mean total length of myotomy of the circular esophagus was 10.5 ± 2.6 cm. No specific complications occurred, with the exception of two patients that developed asymptomatic pneumomediastinum and subcutaneous emphysema. Clinical improvement in symptoms was achieved in all patients. Approximately 77.5% of patients experienced weight gain 6 mo after POEM, with an average of 4.78 kg (range: 2-15 kg). The lower esophageal sphincter resting pressure, four second integrated relaxation pressure and Eckardt scores were all significantly reduced after POEM (Ps < 0.05). A small segment of proximal esophageal peristalsis appeared postoperatively in two patients, but without normal esophageal peristalsis. The average diameter of the esophageal lumen decreased significantly from 4.39 to 3.09 cm (P < 0.01).
  
  
  CONCLUSIONS
  POEM can relieve achalasia symptoms, improve gastroesophageal junction relaxation and restore esophageal body motility function, but not normal esophageal peristalsis.
authors.affiliation: Bin Lu, Meng Li, Yue Hu, Yi Xu, Shuo Zhang, Li-Jun Cai, Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Lu
authors.affiliation: Bin Lu, Meng Li, Yue Hu, Yi Xu, Shuo Zhang, Li-Jun Cai, Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Li
authors.affiliation: Bin Lu, Meng Li, Yue Hu, Yi Xu, Shuo Zhang, Li-Jun Cai, Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Bin Lu, Meng Li, Yue Hu, Yi Xu, Shuo Zhang, Li-Jun Cai, Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Bin Lu, Meng Li, Yue Hu, Yi Xu, Shuo Zhang, Li-Jun Cai, Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China.
authors.forename: Shuo
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Bin Lu, Meng Li, Yue Hu, Yi Xu, Shuo Zhang, Li-Jun Cai, Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China.
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Cai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001466:Barium Sulfate / Q000008:administration & dosage; D002681:China; D003287:Contrast Media / Q000008:administration & dosage; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects; D004947:Esophagus / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009130:Muscle, Smooth / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects; D061646:Operative Time; D011312:Pressure; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate
keywords: Achalasia; High-resolution manometry; Peroral endoscopic myotomy