OBJECTIVETo compare the safety and efficiency of transverse-incision peroral endoscopic myotomy (POEM) with longitudinal-incision POEM.

METHODSPOEM, with a transverse or longitudinal entry incision, was performed in 53 consecutive patients with confirmed achalasia (AC) between December 2010 and September 2012. Data of those patients was collected including the time spent for different procedures and complications.

RESULTSAll the 53 patients underwent POEM successfully, among whom 41 patients had a transverse entry incision and 12 had a longitudinal incision. Treatment success (Eckardt score≤3) with a follow-up for 3-24 months (median 5 month) was achieved in 96.2% of the cases (mean score pre-treatment vs. post-treatment: 7.5 vs 0.6, P<0.001). The whole operation time of transverse-incision group was slightly shorter than that of longitudinal-incision group (65.0∓18.0 min vs 74.1∓18.2 min, P=0.142), but it took much less time in tunnel built-up and muscle dissection in the transverse-incision group (36.3∓9.0 min vs 45.4∓10.5 min; 10.2∓4.6 min vs 15.5∓5.5 min, P<0.05). In addition, patients in transverse incision group were much less likely to develop pneumatosis- related complications [9.8% (4/41) vs 41.7% (5/12), P<0.05). No serious complications occurred in these two groups such as pleural effusion, mediastinitis or digestive tract fistula.

CONCLUSIONSPOEM with a transverse entry incision can significantly decrease the operation time and reduce the incidence of pneumatosis-related complications while obviously relieving the symptoms.