Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2015; 21(30): 9175-9181
Published online Aug 14, 2015. doi: 10.3748/wjg.v21.i30.9175
Peroral endoscopic myotomy for achalasia in patients aged ≥ 65 years
Chen-Jie Li, Yu-Yong Tan, Xue-Hong Wang, De-Liang Liu
Chen-Jie Li, Yu-Yong Tan, Xue-Hong Wang, De-Liang Liu, Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Author contributions: Li CH and Liu DL designed the study; Li CJ, Tan YY, Wang XH and Liu DL acquired the clinical data; Li CJ, Wang XH and Liu DL analyzed the data; Li CJ, Tan YY and Liu DL wrote and revised the paper.
Institutional review board statement: The study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University, Changsha, China.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There was no potential conflict of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: De-Liang Liu, MD, Professor, Director, Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China. liudeliang@medmail.com.cn
Telephone: +86-731-85295035 Fax: +86-731-85295888
Received: March 11, 2015
Peer-review started: March 13, 2015
First decision: April 23, 2015
Revised: May 8, 2015
Accepted: June 9, 2015
Article in press: June 10, 2015
Published online: August 14, 2015
Processing time: 165 Days and 15.1 Hours
Abstract

AIM: To investigate the safety and efficacy of peroral endoscopic myotomy (POEM) for achalasia in patients aged ≥ 65 years.

METHODS: From November 2011 to August 2014, 15 consecutive patients (aged ≥ 65 years) diagnosed with achalasia were prospectively recruited and all underwent POEM at our institution. Eckardt score, lower esophageal sphincter (LES) pressure, esophageal diameter, SF-36 questionnaire, and procedure-related complications were used to evaluate the outcomes.

RESULTS: All 15 patients were treated successfully by POEM, with a median operation time of 55 min. Median myotomy length was 10 cm. Three patients underwent circular myotomy and 12 full-thickness myotomies. Symptoms remitted in all cases during post-POEM follow-up of 6-39 mo. Eckardt score reduced significantly (pre-operation vs post-operation: 8.0 vs 1.0, P < 0.05). Median LES pressure decreased from 27.4 to 9.6 mmHg (P < 0.05). Median diameter of the esophagus was significantly decreased (pre-operation vs post-operation: 51.0 mm vs 30.0 mm, P < 0.05). Only one patient had reflux, which was resolved with oral proton pump inhibitors. No serious complications related to POEM were found. The quality of life of the 15 patients improved significantly after POEM.

CONCLUSION: POEM is a safe and effective technique for treatment of achalasia in patients aged ≥ 65 years, with improvement in symptoms and quality of life.

Keywords: Achalasia; Peroral endoscopic myotomy; Elderly; Efficacy; Quality of life

Core tip: Peroral endoscopic myotomy (POEM) is a novel technique for treatment of achalasia, and has shown exciting results in clinical studies. However, little is known about its efficacy in elderly patients. In the present study, 15 achalasia patients aged ≥ 65 years received POEM. Eckardt score, lower esophageal sphincter pressure, esophageal diameter, SF-36 questionnaire, and procedure-related complications were used to evaluate the outcomes. Our study showed that POEM is a safe and effective therapy for achalasia in elderly patients, with improvement in symptoms and quality of life.