Original article
Clinical endoscopy
Efficacy of anterior versus posterior per-oral endoscopic myotomy for treating achalasia: a randomized, prospective study

https://doi.org/10.1016/j.gie.2018.03.009Get rights and content

Background and Aims

Per-oral endoscopic myotomy (POEM) has been demonstrated to be safe and effective for treating achalasia. Two approaches—anterior myotomy and posterior myotomy—are used during POEM. However, little is known about the comparison between the 2 different approaches. The objective of the study is to compare the safety and short-term efficacy of the 2 approaches for treating achalasia.

Methods

From October 2015 to December 2016, 63 consecutive patients with achalasia without prior treatment or sigmoid-type esophagus were prospectively recruited. They were randomly assigned to an anterior or posterior myotomy group. Clinical data about general characteristics, operative parameters, pre- and postoperative Eckardt score, esophageal manometry results, 24-hour pH test, and adverse events were recorded and compared between the 2 groups.

Results

The anterior group included 31 patients and the posterior group 32 patients. All patients underwent POEM successfully, and treatment success (defined as an Eckardt score ≤3) was achieved in all patients during a mean follow-up of 15.5 months. Mean Eckardt score, lower esophageal sphincter pressure, and 4-second integrated relaxation pressure were significantly decreased (6.2 ± 1.3, 37.5 ± 6.7 mm Hg, and 27.3 ± 4.9 mm Hg vs .70 ± .70, 12.8 ± 2.8 mm Hg, and 11.1 ± 2.3 mm Hg, respectively; P < .01). There was no significant difference between the 2 groups in terms of general characteristics, treatment success, pre- and postoperative esophageal manometry, Eckardt score, and adverse events (P > .05).

Conclusions

The short-term treatment efficacy, manometry outcomes, and adverse events were comparable between the anterior and posterior myotomy groups. Large-scale studies with long-term follow-up are warranted for a more definitive conclusion. (Clinical trial registration number: ChiCTR-ICR-15007211.)

Section snippets

Patients

This was a randomized, prospective, single-center study conducted in China, and the study was approved by the ethics committee of the Second Xiangya Hospital of Central South University. The study was registered at http://www.chictr.org.cn/index.aspx with identifier ChiCTR-ICR-15007211.

Inclusion criteria for enrollment were as follows: (1) achalasia diagnosed based on symptoms, esophageal manometry, EGD, and barium esophagram; (2) age between 18 and 70 years; (3) preoperative Eckardt score no

Patient characteristics

They study enrolled 63 patients (Fig. 3), among whom 34 were women. The average age was 44.1 years (range, 18-69), and the average disease duration was 6.5 years (range, .5-30). According to the Chicago classification,17 7 were type I achalasia, 54 type II, and 2 type III. The mean preoperative Eckardt score, LESP, and 4sIRP were 6.2 ± 1.3, 37.5 ± 6.7 mm Hg, and 27.3 ± 4.9 mm Hg, respectively. There was no significant difference between the 2 groups in gender, age, disease course, achalasia

Discussion

In the present study, we demonstrated for the first time that the short-term treatment efficacy, manometry outcomes, and adverse events were comparable between anterior and posterior myotomy in POEM for treating achalasia. POEM was first reported by Pasricha et al18 in pigs, and then Inoue et al2 performed the world’s first clinical POEM for treating achalasia. A total of 17 patients were treated, and all patients had significant improvement in dysphagia score and LESP. After that, more and

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    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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