Lin YJ, Liu SZ, Li LS, Han K, Shao BZ, Linghu EQ, Chai NL. Repeat peroral endoscopic myotomy with simultaneous submucosal and muscle dissection as a salvage option for recurrent achalasia. World J Gastroenterol 2023; 29(15): 2349-2358 [PMID: 37124882 DOI: 10.3748/wjg.v29.i15.2349]
Corresponding Author of This Article
Ning-Li Chai, MD, Chief Physician, Professor, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. chainingli@vip.163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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/
Yun-Juan Lin, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing 100853, China
Sheng-Zhen Liu, Long-Song Li, Ke Han, Bo-Zong Shao, En-Qiang Linghu, Ning-Li Chai, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Chai NL was the guarantor and designed the study; Lin YJ and Liu SZ participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Li LS, Han K, and Shao BZ revised the article critically for important intellectual content; Linghu EQ and Chai NL were the patient’s endoscopists; and all authors read and approved the final version.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Chinese PLA General Hospital (Approval No. S2021-207-01).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ning-Li Chai, MD, Chief Physician, Professor, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. chainingli@vip.163.com
Received: January 15, 2023 Peer-review started: January 15, 2023 First decision: February 7, 2023 Revised: February 20, 2023 Accepted: March 29, 2023 Article in press: March 29, 2023 Published online: April 21, 2023 Processing time: 88 Days and 21.5 Hours
ARTICLE HIGHLIGHTS
Research background
For recurrent achalasia after initial peroral endoscopic myotomy (POEM) failure, repeat POEM (Re-POEM) has been reported as a treatment option.
Research motivation
Interlayer adhesions caused by previous POEM procedures are common, which could impede the establishment of a submucosal tunnel and even lead to aborted Re-POEM procedures.
Research objectives
This study aimed to evaluate the efficacy and safety of Re-POEM with simultaneous submucosal and muscle dissection (Re-POEM-SSMD) as a salvage therapy for recurrent achalasia with severe esophageal interlayer adhesions after prior failed POEM procedures.
Research methods
Patients diagnosed with recurrent achalasia who underwent Re-POEM or Re-POEM-SSMD in our center were retrospectively analyzed in terms of clinical efficacy, incidence of procedure-related adverse events and reflux complications.
Research results
Clinical success (Eckardt score ≤ 3) was achieved in 8 (88.9%) patients after Re-POEM and 6 (85.7%) patients after Re-POEM-SSMD (P = 0.849). No severe adverse events were recorded in both groups.
Research conclusions
Re-POEM-SSMD could serve as a safe and effective salvage therapy for recurrent achalasia with severe interlayer adhesions.
Research perspectives
Further studies in large-scale patient population and prospective studies are required to verify the efficacy and safety of Re-POEM-SSMD in the management of patients after failed POEM. Further evaluation of the validity of Re-POEM-SSMD in reducing reflux is also awaited.
