Top

Published in:

01-05-2019

Safety and efficacy of using a short tunnel versus a standard tunnel for peroral endoscopic myotomy for Ling type IIc and III achalasia: a retrospective study

Authors: Longsong Li, Ningli Chai, Enqiang Linghu, Zhenjuan Li, Chen Du, Wengang Zhang, Jiale Zou, Ying Xiong, Xiaobin Zhang, Ping Tang

Published in: Surgical Endoscopy | Issue 5/2019

Abstract

Background and AIMS

Peroral endoscopic myotomy (POEM) for patients with Ling type IIc and III achalasia is associated with a high rate of adverse events. Decreasing the lengths of the tunnel and myotomy may be an effective method for reducing this rate. This study aimed to assess the safety and efficacy of using a short tunnel versus a standard tunnel for POEM.

Method

We conducted a retrospective study of 126 patients with Ling type IIc and III achalasia undergoing POEM from January 2013 to December 2016. These patients were divided into a short tunnel group (n = 63) and a standard tunnel group (n = 63). The clinical efficacy of the procedure, operative time, length of the tunnel, length of myotomy and rates of adverse events were analyzed.

Results

The preoperative features were similar in both groups. No significant differences were found between the two groups in Eckardt score change, lower esophageal sphincter (LES) basal pressure or residual pressure after POEM (all p > 0.05). The mean lengths of the tunnel and myotomy were 7.6 cm and 4.8 cm, respectively, in the short tunnel group and 11.8 cm and 9.2 cm, respectively, in the standard tunnel group. The mean operative time of the short tunnel group was significantly shorter than that of the standard tunnel group (39.5 min vs. 48.2 min, respectively, p = 0.001). A significant difference was observed in the rates of procedure-related adverse events between the two groups (9.5% vs. 33.3%, p = 0.001).

Conclusion

The efficacy of the procedure was comparable between the two groups. However, the short tunnel significantly reduced the operation time and the rates of procedure-related adverse events.

Available only for authorised users

Rohof WO, Salvador R, Annese V, Bruley des Varannes S, Chaussade S, Costantini M, Elizalde JI, Gaudric M, Smout AJ, Tack J, Busch OR, Zaninotto G, Boeckxstaens GE (2013) Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology 144 (4):718–725; quiz e713–714. https://doi.org/10.1053/j.gastro.2012.12.027 CrossRefPubMed

Awaiz A, Yunus RM, Khan S, Memon B, Memon MA (2017) Systematic review and meta-analysis of perioperative outcomes of peroral endoscopic myotomy (POEM) and laparoscopic heller myotomy (LHM) for Achalasia. Surg Laparosc Endosc Percutaneous Techn 27(3):123–131. https://doi.org/10.1097/sle.0000000000000402 CrossRef

Khashab MA, El Zein M, Kumbhari V, Besharati S, Ngamruengphong S, Messallam A, Abdelgalil A, Saxena P, Tieu AH, Raja S, Stein E, Dhalla S, Garcia P, Singh VK, Pasricha PJ, Kalloo AN, Clarke JO (2016) Comprehensive analysis of efficacy and safety of peroral endoscopic myotomy performed by a gastroenterologist in the endoscopy unit: a single-center experience. Gastrointest Endosc 83(1):117–125. https://doi.org/10.1016/j.gie.2015.06.013 CrossRefPubMed

Friedel D, Modayil R, Iqbal S, Grendell JH, Stavropoulos SN (2013) Per-oral endoscopic myotomy for achalasia: an American perspective. World J Gastrointest Endosc 5(9):420–427. https://doi.org/10.4253/wjge.v5.i9.420 CrossRefPubMedPubMedCentral

Li HK, Linghu EQ (2013) New endoscopic classification of achalasia for selection of candidates for peroral endoscopic myotomy. World J Gastroenterol 19(4):556–560. https://doi.org/10.3748/wjg.v19.i4.556 CrossRefPubMedPubMedCentral

Chai N, Zhang X, Xiong Y, Ding H, Feng J, Li Y, Yao S, Niu X, Linghu E (2017) Ling classification applied in the preoperative safety and effectiveness assessment of POEM. Surg Endosc 31(1):368–373. https://doi.org/10.1007/s00464-016-4981-z CrossRefPubMed

Phalanusitthepha C, Inoue H, Ikeda H, Sato H, Sato C, Hokierti C (2014) Peroral endoscopic myotomy for esophageal achalasia. Ann Transl Med 2(3):31. https://doi.org/10.3978/j.issn.2305-5839.2014.02.04 CrossRefPubMedPubMedCentral

Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ (2008) Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 135(5):1526–1533. https://doi.org/10.1053/j.gastro.2008.07.022 CrossRefPubMedPubMedCentral

Howard JM, Ryan L, Lim KT, Reynolds JV (2011) Oesophagectomy in the management of end-stage achalasia—case reports and a review of the literature. Int J Surg (London England) 9(3):204–208. https://doi.org/10.1016/j.ijsu.2010.11.010 CrossRef

10.

Devaney EJ, Lannettoni MD, Orringer MB, Marshall B (2001) Esophagectomy for achalasia: patient selection and clinical experience. Ann Thorac Surg 72(3):854–858CrossRefPubMed

11.

Panchanatheeswaran K, Parshad R, Rohila J, Saraya A, Makharia GK, Sharma R (2013) Laparoscopic Heller’s cardiomyotomy: a viable treatment option for sigmoid oesophagus. Interact Cardiovasc Thorac Surg 16(1):49–54. https://doi.org/10.1093/icvts/ivs427 CrossRefPubMed

12.

Sweet MP, Nipomnick I, Gasper WJ, Bagatelos K, Ostroff JW, Fisichella PM, Way LW, Patti MG (2008) The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastroint Surg: Off J Soc Surg Aliment Tract 12(1):159–165. https://doi.org/10.1007/s11605-007-0275-z CrossRef

13.

Watson TJ (2015) Esophagectomy for end-stage achalasia. World J Surg 39(7):1634–1641. https://doi.org/10.1007/s00268-015-3012-x CrossRefPubMed

14.

Molena D, Yang SC (2012) Surgical management of end-stage achalasia. Semin Thorac Cardiovasc Surg 24(1):19–26. https://doi.org/10.1053/j.semtcvs.2012.01.015 CrossRefPubMed

15.

Hu JW, Li QL, Zhou PH, Yao LQ, Xu MD, Zhang YQ, Zhong YS, Chen WF, Ma LL, Qin WZ, Cai MY (2015) Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study. Surg Endosc 29(9):2841–2850. https://doi.org/10.1007/s00464-014-4013-9 CrossRefPubMed

16.

Lv L, Liu J, Tan Y, Liu D (2016) Peroral endoscopic full-thickness myotomy for the treatment of sigmoid-type achalasia: outcomes with a minimum follow-up of 12 months. Eur J Gastroenterol Hepatol 28(1):30–36. https://doi.org/10.1097/meg.0000000000000491 CrossRefPubMed

17.

Stavropoulos SN, Modayil RJ, Friedel D, Savides T (2013) The International Per Oral Endoscopic Myotomy Survey (IPOEMS): a snapshot of the global POEM experience. Surg Endosc 27(9):3322–3338. https://doi.org/10.1007/s00464-013-2913-8 CrossRefPubMed

18.

Zhai Y, Linghu E, Li H, Qin Z, Wang X, Du H, Meng J (2013) Comparison of peroral endoscopic myotomy with transverse entry incision versus longitudinal entry incision for achalasia. Nan fang yi ke da xue xue bao = J South Med Univ 33(9):1399–1402

19.

Ma XB, Wang RL, Li X, Linghu EQ, Gao F (2015) Advances in studies on peroral endoscopic myotomy in treatment of achalasia. Chin J Gastroint Endosc (Electronic Edition) 2(3):108–112

20.

Shen N, Wang X, Zhang X, Yao L, Xie H, Zhang H (2017) Peroral endoscopic myotomy for the treatment of achalasia in a patient with esophageal varices. A case report. J Gastroint Liver Dis: JGLD 26(2):189–192. https://doi.org/10.15403/jgld.2014.1121.262.wan CrossRef

Title: Safety and efficacy of using a short tunnel versus a standard tunnel for peroral endoscopic myotomy for Ling type IIc and III achalasia: a retrospective study
Authors: Longsong Li
Ningli Chai
Enqiang Linghu
Zhenjuan Li
Chen Du
Wengang Zhang
Jiale Zou
Ying Xiong
Xiaobin Zhang
Ping Tang
Publication date: 01-05-2019
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 5/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6414-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Safety and efficacy of using a short tunnel versus a standard tunnel for peroral endoscopic myotomy for Ling type IIc and III achalasia: a retrospective study

Abstract

Background and AIMS

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and AIMS

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2019

Strategies for surgical remediation of the multi-fundoplication failure patient

Comparison of postoperative pain at umbilical wound after conventional laparoscopic cholecystectomy between transumbilical and infraumbilical incisions: a randomized control trial

Morbidity after transanal endoscopic microsurgery: risk factors for postoperative complications and the design of a 1-day surgery program

Laparoscopic liver resection of hepatocellular carcinoma located in unfavorable segments: a propensity score-matched analysis from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery) Registry

Intraoperative confocal laser endomicroscopy for real-time in vivo tissue characterization during surgical procedures

Ileal interposition coupled with duodenal diverted sleeve gastrectomy versus standard medical treatment in type 2 diabetes mellitus obese patients: long-term results of a case–control study