Published online Nov 14, 2016. doi: 10.3748/wjg.v22.i42.9419
Peer-review started: June 22, 2016
First decision: August 29, 2016
Revised: September 12, 2016
Accepted: October 10, 2016
Article in press: October 10, 2016
Published online: November 14, 2016
Processing time: 143 Days and 12.6 Hours
To compare long-term occurrence of gastroesophageal reflux disease (GERD) between two different types of peroral endoscopic myotomy (POEM) for achalasia.
We included all patients with achalasia who underwent POEM at our hospital from August 2011 to October 2012 and had complete GERD evaluation with ≥ 3 years of follow-up. They were divided into circular or full-thickness myotomy groups according to the depth of myotomy. Demographics, Eckardt score, manometry results, 24-h pH monitoring, and GERD symptoms were recorded and compared between the two groups.
We studied 56 patients (32 circular myotomy and 24 full-thickness myotomy) with complete GERD evaluation. There was no significant difference between the two groups in terms of treatment success (defined as Eckardt score ≤ 3), postoperative Eckardt score, mean basal lower esophageal sphincter pressure, and 4-s integrated relaxation pressure (4sIRP). Postoperative abnormal esophageal acid exposure was found in 25 patients (44.6%). A total of 13 patients (23.2%) had GERD symptoms and 12 had esophagitis (21.4%). Clinically relevant GERD (abnormal esophageal acid exposure associated with GERD symptoms and/or esophagitis) was diagnosed in 13 patients (23.2%). Multivariate analysis revealed that full-thickness myotomy and low level of postoperative 4sIRP were predictive factors for clinically relevant GERD.
Efficacy and manometry are comparable between achalasia patients treated with circular or full-thickness myotomy. But patients with full-thickness myotomy and low postoperative 4sIRP have more GERD.
Core tip: Gastroesophageal reflux disease (GERD) is a major concern following peroral endoscopic myotomy for achalasia. Although short-term follow-up did not show an increased rate of GERD in patients who received full-thickness myotomy compared with circular myotomy, the long-term difference is still unknown. We found that full-thickness myotomy is associated with a higher rate of clinically relevant GERD.