Peroral endoscopic myotomy for idiopathic achalasia: randomized comparison of water-jet assisted versus conventional dissection technique
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Peroral endoscopic myotomy (POEM) has recently been introduced as a promising alternative to laparoscopic Heller myotomy for idiopathic achalasia. Several proposed technical modifications are yet to be tested in randomized trials.
The objective of our study was to evaluate efficacy and safety of water-jet (WJ) assisted POEM versus the conventional (C) technique. The clinical trial registration number is NCT01742494.
A prospective randomized trial was carried out in Zhongshan Hospital, Fudan University (Shanghai, China), in 100 consenting achalasia patients between August 2011 and April 2012. Patients eligible for POEM were randomized to use of either the HybridKnife (WJ group) or the conventional technique using injection and triangle tip knife interchangeably (C group).
A total of 100 patients with comparable characteristics between groups were included. Procedure time was significantly shorter for the WJ group (22.9 ± 6.7 vs. 35.9 ± 11.7 min; p < 0.0001), mostly due to less replacement of accessories (2.0 ± 2.4 vs. 19.2 ± 7.6; p < 0.0001). Injection volume was larger in the WJ group (45.3 ± 10.2 vs. 35.2 ± 9.5 ml; p < 0.0001) and was associated with fewer minor bleeding episodes (3.6 ± 1.8 vs. 6.8 ± 5.2; p < 0.0001). No severe complications occurred; one case of cutaneous emphysema occurred in the WJ group, and four cases occurred in the C group (p = 0.17), three cases of pneumonia were encountered in the C group and none in the WJ group (p = 0.24). Treatment success (Eckardt score ≤3) was achieved in 96.5 % of patients, with no significant differences between groups.
The use of the HybridKnife leads to a significant decrease in POEM procedure time and facilitates reinjection, possibly contributing to a lower rate of minor intra-procedural bleeding.
- Pohl D, Tutuian R (2007) Achalasia: an overview of diagnosis and treatment. J Gastrointes Liver Dis 16:297–303
- Chan KC, Wong SK, Lee DW et al (2004) Short-term and long-term results of endoscopic balloon dilation for achalasia: 12 years’ experience. Endoscopy 36:690–694 CrossRef
- Kilic A, Schuchert MJ, Pennathur A et al (2009) Long-term outcomes of laparoscopic Heller myotomy for achalasia. Surgery 146:826–831 discussion 831–823 CrossRef
- Cowgill SM, Villadolid D, Boyle R et al (2009) Laparoscopic Heller myotomy for achalasia: results after 10 years. Surg Endosc 23:2644–2649 CrossRef
- Weber CE, Davis CS, Kramer HJ et al (2012) Medium and long-term outcomes after pneumatic dilation or laparoscopic Heller myotomy for achalasia: a meta-analysis. Surg Laparosc Endosc Percutan Tech 22:289–296 CrossRef
- Boeckxstaens GE, Annese V, des Varannes SB et al (2011) Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med 364:1807–1816 CrossRef
- Costamagna G, Marchese M, Familiari P et al (2012) Peroral endoscopic myotomy (POEM) for oesophageal achalasia: preliminary results in humans. Dig Liver Dis 44:827–832 CrossRef
- von Renteln D, Inoue H, Minami H et al (2011) Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol 107:411–417 CrossRef
- Inoue H, Minami H, Kobayashi Y et al (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271 CrossRef
- Swanstrom LL, Rieder E, Dunst CM (2011) A stepwise approach and early clinical experience in peroral endoscopic myotomy for the treatment of achalasia and esophageal motility disorders. J Am Coll Surg 213:751–756 CrossRef
- Lingenfelder T, Fischer K, Sold MG et al (2009) Combination of water-jet dissection and needle-knife as a hybrid knife simplifies endoscopic submucosal dissection. Surg Endosc 23:1531–1535 CrossRef
- Schumacher B, Charton JP, Nordmann T et al (2012) Endoscopic submucosal dissection of early gastric neoplasia with a water jet-assisted knife: a Western, single-center experience. Gastrointest Endosc 75:1166–1174 CrossRef
- Ren Z, Zhong Y, Zhou P et al (2012) Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases). Surg Endosc 26:3267–3272 CrossRef
- Ott DJ, Richter JE, Chen YM et al (1987) Esophageal radiography and manometry: correlation in 172 patients with dysphagia. AJR Am J Roentgenol 149:307–311 CrossRef
- El-Takli I, O’Brien P, Paterson WG (2006) Clinical diagnosis of achalasia: how reliable is the barium X-ray? Can J Gastroenterol 20:335–337
- Peroral endoscopic myotomy for idiopathic achalasia: randomized comparison of water-jet assisted versus conventional dissection technique
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Peroral endoscopic myotomy (POEM)
- Water-jet assisted procedure
- Industry Sectors
- Author Affiliations
- 1. Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People’s Republic of China