Factors predicting the technical difficulty of peroral endoscopic myotomy for achalasia
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Peroral endoscopic myotomy (POEM) has been described as a novel treatment for esophageal achalasia. Owing to its technical difficulty, POEM is not widely performed. This study was aimed to prospectively assess the factor predicting technical difficulty of POEM in a single center with large volume cases.
A total of 105 cases of achalasia treated by POEM from April 2011 to September 2014 were analyzed. Difficult cases of POEM were defined as procedure time ≥90 min and occurrence of adverse events, including mucosal perforation, pneumothorax, and major bleeding. Univariate and multivariate logistic regression analyses were performed to assess the predictive factors of difficult POEM.
POEM was successfully completed in all the patients, and no one was converted to laparoscopy. The number of cases with procedure time ≥90 min was 17. Mucosal perforations occurred in six (5.7 %) patients during submucosal tunnel creation, major bleeding occurred in seven (6.7 %) patients, and pneumothorax occurred in six (5.7 %) patients immediately after procedure. All the complications were managed conservatively. No other intraoperative and immediate postoperative complications, including infections and pneumoperitoneum, occurred. Multivariate analysis showed that early period (odds ratio [OR] 4.173, 95 % confidence interval [95 % CI] 1.36–6.829, P = 0.023) and triangular tip knife ([OR] 6.712, [95 % CI] 1.479–30.460, P = 0.014) were independent factors associated with technical difficulty regarding longer procedure time (procedure time ≥90 min).
POEM is safe for the treatment of esophageal achalasia. Triangular tip knife and early period were independent risk factors for longer procedural time.
KeywordsEsophageal achalasia Peroral endoscopic myotomy Technical difficulty Complication Predictor
This study was supported by the grant from the National Natural Science Foundation of China (No. 81101610), Scientific Research Projects of Guangdong Province (No. 2013B021800311), and Medical Research Foundation of Guangdong Province (No. WSTJJ2011110142092192119760913465X).
Compliance with ethical standards
Drs. Xiaowei Tang, Yutang Ren, Zhengjie Wei, Zhiliang Deng, Jieqiong Zhou, Zhenyu Chen, Bo Jiang, and Wei Gong have no conflicts of interest or financial ties to disclose.
- 4.Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttitta A, Elizalde JI, Fumagalli U, Gaudric M, Rohof WO, Smout AJ, Tack J, Zwinderman AH, Zaninotto G, Busch OR, European Achalasia Trial I (2011) Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med 364(19):1807–1816CrossRefPubMedGoogle Scholar
- 16.Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AJ, International High Resolution Manometry Working G (2012) Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil 24(Suppl 1):57–65CrossRefPubMedPubMedCentralGoogle Scholar