title: Feasibility and safety of peroral endoscopic myotomy for achalasia after failed endoscopic interventions.
abstract: With advances in natural orifice transluminal endoscopic surgery, peroral endoscopic myotomy (POEM) has become a novel treatment for esophageal achalasia. In this study, we investigated the feasibility and safety of POEM in patients with achalasia after failed endoscopic interventions. Data on all patients undergoing POEM treatment of achalasia were collected prospectively. We enrolled 61 patients who underwent POEM for achalasia between July 2011 and January 2014. The preoperative intervention group included patients who had undergone botulinum toxin injection or pneumatic balloon dilation before POEM. The preoperative, operative, and short-term outcome data between the groups were compared. Among preoperative intervention group, 22 patients received endoscopic therapy before being referred for operation (18 dilation only, 2 botulinum toxin only, and 2 both treatments). Procedure time in the preoperative intervention group was similar to the nonpreoperative intervention group (60.8 ± 30.9 vs. 62.0 ± 21.0 minutes, P = 0.863). Both groups demonstrated significant improvement in Eckardt scores and manometric outcomes at 1-year follow-up. There were no significant differences in pretreatment and posttreatment D-values of symptom scores and lower esophageal sphincter pressures between groups (6.2 ± 2.2 vs. 6.1 ± 1.8, P = 0.840; 27.9 ± 17.6 vs. 24.9 ± 15.2; P = 0.569). There was also no significant difference in the incidence of intraoperative complications (P = 0.958) and gastroesophageal reflux rate (23.5% vs. 20.0%, P = 0.771) between the two groups. Our study demonstrated that POEM is safe and effective, even for treating achalasia in the setting of failed endoscopic interventions.
authors.affiliation: Department of Gastroenterology, Guangdong Provincial key laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.|Departmemt of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Beijing, China.
authors.forename: X
authors.initials: X
authors.lastname: Tang
authors.affiliation: Department of Gastroenterology, Guangdong Provincial key laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: W
authors.initials: W
authors.lastname: Gong
authors.affiliation: Department of Gastroenterology, Guangdong Provincial key laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Deng
authors.affiliation: Department of Gastroenterology, Guangdong Provincial key laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.|Departmemt of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Beijing, China.
authors.forename: J
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Departmemt of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Ren
authors.affiliation: Department of Gastroenterology, Guangdong Provincial key laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Q
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology, Guangdong Provincial key laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, Guangdong Provincial key laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.|Departmemt of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Beijing, China.
authors.forename: B
authors.initials: B
authors.lastname: Jiang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: balloon dilation; botulinum toxin; esophageal achalasia; peroral endoscopic myotomy