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


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.


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.


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).


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.

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Correspondence to Enqiang Linghu.

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Longsong Li, Ningli Chai, Enqiang Linghu, Zhenjuan Li, Chen Du, Wengang Zhang, Jiale Zou, Ying Xiong, Xiaobin Zhang, and Ping Tang have no conflicts of interest or financial ties to disclose.

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Li, L., Chai, N., Linghu, E. et al. 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. Surg Endosc 33, 1394–1402 (2019) doi:10.1007/s00464-018-6414-7

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  • Peroral endoscopic myotomy
  • Achalasia
  • Ling classification
  • Short tunnel