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.)

中文翻译：

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前后经口内镜下肌切开术治疗门失弛缓症的疗效：一项随机，前瞻性研究

背景和目标

经口内镜下肌切开术（POEM）已被证明可安全有效地治疗门失弛缓症。POEM期间使用两种方法-前肌切开术和后肌切开术。但是，人们对两种不同方法之间的比较了解甚少。该研究的目的是比较两种治疗门失弛缓症的安全性和短期疗效。

方法

从2015年10月至2016年12月，前瞻性招募了63例没有事先治疗或乙状结肠食管的门失弛缓患者。他们被随机分配到前或后肌切开术组。记录并比较两组患者的一般特征，手术参数，术前和术后Eckardt评分，食管测压结果，24小时pH测试以及不良事件的临床数据。

结果

前组包括31例患者，后组包括32例患者。所有患者均成功进行了POEM，平均随访时间为15.5个月，所有患者均获得了成功的治疗（定义为Eckardt评分≤3）。平均Eckardt评分，较低的食管括约肌压力和4秒综合松弛压力显着降低（6.2±1.3、37.5±6.7 mm Hg和27.3±4.9 mm Hg与.70±.70、12.8±2.8 mm Hg和分别为11.1±2.3 mm Hg; P  <.01）。两组在总体特征，治疗成功率，术前和术后食管测压，Eckardt评分和不良事件方面无显着差异（P > 0.05）。

结论

前后肌切开术组的短期治疗效果，测压结果和不良事件相当。值得进行长期随访的大规模研究得出更明确的结论。（临床试验注册号：ChiCTR-ICR-15007211。）