Abstract: Objective:To compare the efficacy and safety of full thickness peroral endoscopic myotomy (POEM) and circular myotomy for patients with severe achalasia.
Methods:The clinical data of 123 patients with severe achalasia who were admitted to the Second Xiangya Hospital of Central South University from August 2011 to May 2013 were retrospectively analyzed. Seventy patients who received full thickness POEM were in the full thickness myotomy group, and the other 53 patients who received circular myotomy were in the circular myotomy group. The clinical efficacies and incidences of complications of the 2 groups were compared. Patients in the 2 groups were followed up at the out patient department till May 2014. The consecutive measurement data were presented by ±s and analyzed using the t test; the non consecutive data were presented by M (range) and analyzed using the Wilcoxon rank test. Data before and after operation were compared using the repeated measure of analysis of variance. The count data were analyzed using the chi square test.
Results:All the patients successfully received POEM. The operation time of the full thickness myotomy group and the circular myotomy group were (57±8)minutes and (63±12)minutes, with significant difference between the 2 groups (t=3.421, P<0.05). The incidences of complications of the full thickness myotomy group and the circular myotomy group were 14.3% (10/70) and 11.3%(6/53), with no significant difference between the 2 groups (χ2 =0.234, P>0.05). A total of 119 patients were followed up, with the median time of 18 months (range, 12 -24 months). The Eckardt scores at postoperative month 6 and 12 were 0 (range, 0 -3) and 0 (range, 0 -3) in the full thickness myotomy group, and 0 (range, 0 -2) and 0 (range, 0 -3) in the circular myotomy group, with no significant difference between the 2 groups (Z=0.525, 1.476, P>0.05). The sussess rates of the full thickness myotomy group and the circular myotomy group were 98.6%(69/70) and 98.1%(52/53), with no significant difference between the 2 groups (χ2 =0.040, P>0.05). The diameters of the esophagus at postoperative month 6 of the full thickness myotomy group and the circular myotomy group were (3.2±0.3)cm and (3.4±0.4)cm, with no significant difference between the 2 groups (t=1.927, P>0.05). The diameters of the esophagus at postoperative month 6 and 12 were significantly lesser than (5.9±1.0)cm and (5.9±1.0)cm before operation (F=780.923, 493.018, P<0.05). No recurrence was detected in the 2 groups during the follow up.
Conclusion:The short term efficacy and incidence of complications of full thickness myotomy and circular myotomy are comparable, while the operation time of patients who received full thickness myotomy is shorter.