title: Full-thickness myotomy is associated with higher rate of postoperative gastroesophageal reflux disease.
abstract: OBJECTIVE
  To compare long-term occurrence of gastroesophageal reflux disease (GERD) between two different types of peroral endoscopic myotomy (POEM) for achalasia.
  
  
  METHODS
  We included all patients with achalasia who underwent POEM at our hospital from August 2011 to October 2012 and had complete GERD evaluation with ≥ 3 years of follow-up. They were divided into circular or full-thickness myotomy groups according to the depth of myotomy. Demographics, Eckardt score, manometry results, 24-h pH monitoring, and GERD symptoms were recorded and compared between the two groups.
  
  
  RESULTS
  We studied 56 patients (32 circular myotomy and 24 full-thickness myotomy) with complete GERD evaluation. There was no significant difference between the two groups in terms of treatment success (defined as Eckardt score ≤ 3), postoperative Eckardt score, mean basal lower esophageal sphincter pressure, and 4-s integrated relaxation pressure (4sIRP). Postoperative abnormal esophageal acid exposure was found in 25 patients (44.6%). A total of 13 patients (23.2%) had GERD symptoms and 12 had esophagitis (21.4%). Clinically relevant GERD (abnormal esophageal acid exposure associated with GERD symptoms and/or esophagitis) was diagnosed in 13 patients (23.2%). Multivariate analysis revealed that full-thickness myotomy and low level of postoperative 4sIRP were predictive factors for clinically relevant GERD.
  
  
  CONCLUSIONS
  Efficacy and manometry are comparable between achalasia patients treated with circular or full-thickness myotomy. But patients with full-thickness myotomy and low postoperative 4sIRP have more GERD.
authors.affiliation: Xue-Hong Wang, Yu-Yong Tan, Hong-Yi Zhu, Chen-Jie Li, De-Liang Liu, Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China.
authors.forename: Xue-Hong
authors.initials: XH
authors.lastname: Wang
authors.affiliation: Xue-Hong Wang, Yu-Yong Tan, Hong-Yi Zhu, Chen-Jie Li, De-Liang Liu, Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China.
authors.forename: Yu-Yong
authors.initials: YY
authors.lastname: Tan
authors.affiliation: Xue-Hong Wang, Yu-Yong Tan, Hong-Yi Zhu, Chen-Jie Li, De-Liang Liu, Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China.
authors.forename: Hong-Yi
authors.initials: HY
authors.lastname: Zhu
authors.affiliation: Xue-Hong Wang, Yu-Yong Tan, Hong-Yi Zhu, Chen-Jie Li, De-Liang Liu, Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China.
authors.forename: Chen-Jie
authors.initials: CJ
authors.lastname: Li
authors.affiliation: Xue-Hong Wang, Yu-Yong Tan, Hong-Yi Zhu, Chen-Jie Li, De-Liang Liu, Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China.
authors.forename: De-Liang
authors.initials: DL
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D050782:Esophageal pH Monitoring; D004945:Esophagoscopy / Q000009:adverse effects* / Q000379:methods; D004947:Esophagus / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009130:Muscle, Smooth / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Achalasia; Circular myotomy; Full-thickness myotomy; Gastroesophageal reflux disease; Peroral endoscopic myotomy