Comparison between double-tunnel and traditional peroral endoscopic myotomy for achalasia cardia
10.3760/cma.j.cn321463-20201222-00758
- VernacularTitle:双隧道与单隧道经口内镜下肌切开术治疗贲门失弛缓症的疗效比较
- Author:
Lei PENG
1
;
Weifeng ZHANG
;
Yun WANG
;
Jie HUA
;
Chunhua JIAO
;
Xinmin SI
;
Guoxin ZHANG
Author Information
1. 南京医科大学第一附属医院消化内科，南京 210029
- Keywords:
Cardia;
Esophageal achalasia;
Peroral endoscopic myotomy;
Double tunnel;
Gastroesophageal reflux
- From:
Chinese Journal of Digestive Endoscopy
2022;39(2):103-107
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the long-term efficacy of double-tunnel peroral endoscopic myotomy (POEM) and traditional POEM in the treatment of achalasia cardia.Methods:A randomized controlled trial was performed on the data of 30 patients with achalasia cardia, who underwent POEM in the First Affiliated Hospital of Nanjing Medical University from June 2018 to June 2019. The 30 consecutive patients were randomly assigned to double-tunnel POEM group (15 cases, a second tunnel was established opposite to the traditional one) and traditional POEM group (15 cases). Intraoperative information was recorded, and patients were followed up regularly to compare the efficacy and complications between the two groups.Results:Double-tunnel POEM and traditional POEM were all completed with technical success. There were no significant differences in the intraoperative complications (5/15 VS 4/15, P=1.000), hospitalization time or cost between the two groups. The follow-up time was 17.20±4.83 months and 15.33±4.67 months in the traditional POEM group and the double-tunnel POEM group, respectively. The Eckardt scores after surgery between the two groups had no significant difference [1.53 (2.00) VS 1.60 (3.00), Z=-0.363, P=0.744]. The symptom relief cases were both 14 in the two groups. The postoperative 4-second integrated relaxation pressure (4 s IRP) of the double-tunnel group (11.27±3.14 mmHg) was significantly lower than that of the traditional group (15.05±4.21 mmHg, t=2.794, P=0.009). There was no significant difference in postoperative gastroesophageal reflux disease questionnaire scores between the two groups (4.40±1.64 VS 4.20±1.42, t=0.357, P=0.724). Conclusion:Double-tunnel POEM has almost the same efficacy as the traditional POEM except for a lower post-POEM 4 sIRP.
