Analysis of Efficacy, Safety and Influential Factors of Peroral Endoscopic Myotomy in Geriatric Patients With Achalasia
10.3969/j.issn.1008-7125.2021.04.004
- Author:
Haisheng QIAN
1
;
Xinmin SI
1
;
Weifeng ZHANG
1
;
Jie HUA
1
;
Meifeng WANG
1
;
Guoxin ZHANG
1
;
Yun WANG
1
Author Information
1. Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University
- Publication Type:Journal Article
- Keywords:
Aged;
Esophageal Achalasia;
Peroral Endoscopic Myotomy;
Therapy
- From:
Chinese Journal of Gastroenterology
2021;26(4):212-217
- CountryChina
- Language:Chinese
-
Abstract:
Background: Peroral endoscopic myotomy (POEM) is safe and effective in the treatment of achalasia (AC). However, there are few reports on application of POEM in the elderly, and is limited by small sample size and short follow-up. Aims: To evaluate the efficacy and safety of POEM and its influential factors on AC in geriatric patients. Methods: A total of 215 AC patients received POEM from November 2012 to December 2018 at the First Affiliated Hospital of Nanjing Medical University were enrolled, and were divided into elderly group (≥60 years old) and non-elderly group (<60 years old). The clinical information, POEM procedure, efficacy and safety were compared, follow-up was performed, and influential factors were analyzed. Results: The disease course in elderly group was significantly longer than that in non-elderly group (P=0.002); the integrated relaxation pressure (IRP) of lower esophageal sphincter in elderly group was significantly decreased than that in non-elderly group (P=0.013). No significant differences in basic information, Chicago classification, POEM procedure, postoperative Eckardt score between the two groups were found (P>0.05). The median follow-up was 42 (29, 60) months. The rate of treatment failure or recurrence in elderly group was significantly increased than that in non-elderly group (17.5% vs. 7.4%, P=0.047). However, there was no statistical difference in incidence of clinical reflux between the two groups (P>0.05). The postoperative efficacy was correlated with preoperative IRP in elderly patients (P=0.033). The propensity score matching results showed that no significant difference in prognosis was found between the two groups. Conclusions: POEM is safe and effective for elderly patients with AC. However, the efficacy is lower in elderly patients than that in non-elderly patients due to the long course of disease and lower preoperative IRP.
