Comparison of clinical effect between laparoscopic Heller myotomy and peroral endoscopic myotomy for achalasia_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Cong ¹ , WANG Feitong ² , NIU Jian ² , WEI Xin ² ,  LIU Bin ²

1. Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;
2. Department of General Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;

Corresponding author：

LIU Bin, Email: liubin@xzmc.edu.cn

Keywords：

achalasia; laparoscopic Heller myotomy; peroral endoscopic myotomy; clinical effect

DOI：

10.7507/1007-9424.202008118

Video：

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Objective To compare the clinical effect of laparoscopic Heller myotomy (LHM) combined with Dor fundoplication and peroral endoscopic myotomy (POEM) in treatment of patients with achalasia.Methods The clinical data of 67 patients with achalasia from January 2014 to December 2018 in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. Among them, 19 patients received the LHM combined with Dor fundoplication (LHM group), 48 patients received the POEM (POEM group). The clinical efficacy and safety of the two groups were compared.Results There were no significant differences in the baseline data such as the gender, age, course of disease, body mass index, preoperative Eckardt score, preoperative maximum diameter of esophagus, and previous treatment history between the two groups (P>0.05). There were no significant differences in the operation time, bleeding volume, the Eckardt points at 3 and 12 months after operation, the decrease degree of maximum diameter of esophagus, complications (except for gastroesophageal reflux, P=0.029), and recurrence rate between the two groups (P>0.05). The total hospitalization time, postoperative hospitalization time, and total hospitalization costs of the POEM group were lower than those of the LHM group (P<0.05).Conclusions Both LHM and POEM could effectively relieve clinical symptoms, short-term efficacy and safety of the two kinds of operations are similar. Postoperative recovery of POEM is fast and hospitalization cost is less, but incidence of gastroesophageal reflux is higher.

Citation： WANG Cong, WANG Feitong, NIU Jian, WEI Xin, LIU Bin. Comparison of clinical effect between laparoscopic Heller myotomy and peroral endoscopic myotomy for achalasia. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(5): 641-644. doi: 10.7507/1007-9424.202008118 Copy

1.	Pandolfino JE, Kahrilas PJ. Presentation, diagnosis, and manage ment of achalasia. Clin Gastroenterol Hepatol, 2013, 11(8): 887-897.
2.	Jeon HH, Kim JH, Youn YH, et al. Clinical characteristics of patients with untreated achalasia. J Neurogastroenterol Motil, 2017, 23(3): 378-384.
3.	Costantino CL, Geller AD, Visenio MR, et al. Outcomes of laparoscopic Heller myotomy for achalasia: 22-year experience. J Gastrointest Surg, 2020, 24(6): 1411-1416.
4.	庄羽骁, 胡颖. 经口内镜下肌切开术治疗贲门失弛缓症的现状和进展. 胃肠病学和肝病学杂志, 2019, 28(8): 942-946.
5.	Marano L, Pallabazzer G, Solito B, et al. Surgery or peroral esophageal myotomy for achalasia: a systematic review and meta-analysis. Medicine (Baltimore), 2016, 95(10): e3001.
6.	Park CH, Jung DH, Kim DH, et al. Comparative efficacy of per-oral endoscopic myotomy and Heller myotomy in patients with achalasia: a meta-analysis. Gastrointest Endosc, 2019, 90(4): 546-558.
7.	苏福增, 张成, 克力木, 等. 腹腔镜 Nissen、Toupet 和 Dor 胃底折叠术治疗食管裂孔疝合并胃食管反流病的疗效对比分析. 中华胃肠外科杂志, 2016, 19(9): 1014-1020.
8.	Ahmed Y, Othman MO. Peroral endoscopic myotomy (POEM) for achalasia. J Thorac Dis, 2019, 11(Suppl 12): S1618-S1628.
9.	Huang ZZ, Cui Y, LI YQ, et al. Peroral endoscopic myotomy for achalasia patients with prior Heller myotomy: a systematic review and meta-analysis. Gastrointest Endosc, 2021, 93(1): 47-56.e5.
10.	Sadowski DC, Ackah F, Jiang B, et al. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil, 2010, 22(9): e256-e261.
11.	van Hoeij FB, Ponds FA, Smout AJ, et al. Incidence and costs of achalasia in The Netherlands. Neurogastroenterol Motil, 2018, 30(2).
12.	杨烁, 徐洪雨. 贲门失驰缓症的诊断与治疗的进展及未来前景. 胃肠病学和肝病学杂志, 2020, 29(4): 462-465.
13.	von Rahden BHA. Current treatment of achalasia 2019. Zentralbl Chir, 2019, 144(2): 163-170.
14.	Shimi S, Nathanson LK, Cuschieri A. Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb, 1991, 36(3): 152-154.
15.	Schlottmann F, Luckett DJ, Fine J, et al. Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis. Ann Surg, 2018, 267(3): 451-460.
16.	Torres-Villalobos G, Martin-Del-Campo LA. Surgical treatment for achalasia of the esophagus: laparoscopic Heller myotomy. Gastroenterol Res Pract, 2013, 2013: 708327.
17.	Richards WO, Torquati A, Holzman MD, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg, 2004, 240(3): 405-412.
18.	Schlottmann F, Patti MG. Esophageal achalasia: current diagnosis and treatment. Expert Rev Gastroenterol Hepatol, 2018, 12(7): 711-721.
19.	周成, 孙鹏飞, 臧书源, 等. 腹腔镜 Heller 术+Dor 胃底折叠术治疗贲门失弛缓症的效果. 实用临床医药杂志, 2018, 22(9): 58-60, 64.
20.	Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy, 2010, 42(4): 265-271.
21.	Von Renteln D, Fuchs KH, Fockens P, et al. Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology, 2013, 145(2): 309-311.
22.	姜晗. 经口内镜下肌切开术与球囊扩张术治疗贲门失弛缓症的临床疗效对比. 广西医学, 2019, 41(5): 644-646.
23.	Sharata AM, Dunst CM, Pescarus R, et al. Peroral endoscopic myotomy (POEM) for esophageal primary motility disorders: analysis of 100 consecutive patients. J Gastrointest Surg, 2015, 19(1): 161-170.

1. Pandolfino JE, Kahrilas PJ. Presentation, diagnosis, and manage ment of achalasia. Clin Gastroenterol Hepatol, 2013, 11(8): 887-897.
2. Jeon HH, Kim JH, Youn YH, et al. Clinical characteristics of patients with untreated achalasia. J Neurogastroenterol Motil, 2017, 23(3): 378-384.
3. Costantino CL, Geller AD, Visenio MR, et al. Outcomes of laparoscopic Heller myotomy for achalasia: 22-year experience. J Gastrointest Surg, 2020, 24(6): 1411-1416.
4. 庄羽骁, 胡颖. 经口内镜下肌切开术治疗贲门失弛缓症的现状和进展. 胃肠病学和肝病学杂志, 2019, 28(8): 942-946.
5. Marano L, Pallabazzer G, Solito B, et al. Surgery or peroral esophageal myotomy for achalasia: a systematic review and meta-analysis. Medicine (Baltimore), 2016, 95(10): e3001.
6. Park CH, Jung DH, Kim DH, et al. Comparative efficacy of per-oral endoscopic myotomy and Heller myotomy in patients with achalasia: a meta-analysis. Gastrointest Endosc, 2019, 90(4): 546-558.
7. 苏福增, 张成, 克力木, 等. 腹腔镜 Nissen、Toupet 和 Dor 胃底折叠术治疗食管裂孔疝合并胃食管反流病的疗效对比分析. 中华胃肠外科杂志, 2016, 19(9): 1014-1020.
8. Ahmed Y, Othman MO. Peroral endoscopic myotomy (POEM) for achalasia. J Thorac Dis, 2019, 11(Suppl 12): S1618-S1628.
9. Huang ZZ, Cui Y, LI YQ, et al. Peroral endoscopic myotomy for achalasia patients with prior Heller myotomy: a systematic review and meta-analysis. Gastrointest Endosc, 2021, 93(1): 47-56.e5.
10. Sadowski DC, Ackah F, Jiang B, et al. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil, 2010, 22(9): e256-e261.
11. van Hoeij FB, Ponds FA, Smout AJ, et al. Incidence and costs of achalasia in The Netherlands. Neurogastroenterol Motil, 2018, 30(2).
12. 杨烁, 徐洪雨. 贲门失驰缓症的诊断与治疗的进展及未来前景. 胃肠病学和肝病学杂志, 2020, 29(4): 462-465.
13. von Rahden BHA. Current treatment of achalasia 2019. Zentralbl Chir, 2019, 144(2): 163-170.
14. Shimi S, Nathanson LK, Cuschieri A. Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb, 1991, 36(3): 152-154.
15. Schlottmann F, Luckett DJ, Fine J, et al. Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis. Ann Surg, 2018, 267(3): 451-460.
16. Torres-Villalobos G, Martin-Del-Campo LA. Surgical treatment for achalasia of the esophagus: laparoscopic Heller myotomy. Gastroenterol Res Pract, 2013, 2013: 708327.
17. Richards WO, Torquati A, Holzman MD, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg, 2004, 240(3): 405-412.
18. Schlottmann F, Patti MG. Esophageal achalasia: current diagnosis and treatment. Expert Rev Gastroenterol Hepatol, 2018, 12(7): 711-721.
19. 周成, 孙鹏飞, 臧书源, 等. 腹腔镜 Heller 术+Dor 胃底折叠术治疗贲门失弛缓症的效果. 实用临床医药杂志, 2018, 22(9): 58-60, 64.
20. Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy, 2010, 42(4): 265-271.
21. Von Renteln D, Fuchs KH, Fockens P, et al. Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology, 2013, 145(2): 309-311.
22. 姜晗. 经口内镜下肌切开术与球囊扩张术治疗贲门失弛缓症的临床疗效对比. 广西医学, 2019, 41(5): 644-646.
23. Sharata AM, Dunst CM, Pescarus R, et al. Peroral endoscopic myotomy (POEM) for esophageal primary motility disorders: analysis of 100 consecutive patients. J Gastrointest Surg, 2015, 19(1): 161-170.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of clinical effect between laparoscopic Heller myotomy and peroral endoscopic myotomy for achalasia

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