PMID- 36156932
OWN - NLM
STAT- MEDLINE
DCOM- 20220928
LR  - 20220928
IS  - 2219-2840 (Electronic)
IS  - 1007-9327 (Print)
IS  - 1007-9327 (Linking)
VI  - 28
IP  - 33
DP  - 2022 Sep 7
TI  - Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for 
      esophageal achalasia: A single-center randomized controlled trial.
PG  - 4875-4889
LID - 10.3748/wjg.v28.i33.4875 [doi]
AB  - BACKGROUND: Achalasia is a rare benign esophageal motor disorder characterized by 
      incomplete relaxation of the lower esophageal sphincter (LES). The treatment of 
      achalasia is not curative, but rather is aimed at reducing LES pressure. In 
      patients who have failed noninvasive therapy, surgery should be considered. 
      Myotomy with partial fundoplication has been considered the first-line treatment 
      for non-advanced achalasia. Recently, peroral endoscopic myotomy (POEM), a 
      technique that employs the principles of submucosal endoscopy to perform the 
      equivalent of a surgical myotomy, has emerged as a promising minimally invasive 
      technique for the management of this condition. AIM: To compare POEM and 
      laparoscopic myotomy and partial fundoplication (LM-PF) regarding their efficacy 
      and outcomes for the treatment of achalasia. METHODS: Forty treatment-naive adult 
      patients who had been diagnosed with achalasia based on clinical and manometric 
      criteria (dysphagia score >/= II and Eckardt score > 3) were randomized to undergo 
      either LM-PF or POEM. The outcome measures were anesthesia time, procedure time, 
      symptom improvement, reflux esophagitis (as determined with the Gastroesophageal 
      Reflux Disease Questionnaire), barium column height at 1 and 5 min (on a barium 
      esophagogram), pressure at the LES, the occurrence of adverse events (AEs), 
      length of stay (LOS), and quality of life (QoL). RESULTS: There were no 
      statistically significant differences between the LM-PF and POEM groups regarding 
      symptom improvement at 1, 6, and 12 mo of follow-up (P = 0.192, P = 0.242, and P 
      = 0.242, respectively). However, the rates of reflux esophagitis at 1, 6, and 12 
      mo of follow-up were significantly higher in the POEM group (P = 0.014, P < 
      0.001, and P = 0.002, respectively). There were also no statistical differences 
      regarding the manometry values, the occurrence of AEs, or LOS. Anesthesia time 
      and procedure time were significantly shorter in the POEM group than in the LM-PF 
      group (185.00 +/- 56.89 and 95.70 +/- 30.47 min vs 296.75 +/- 56.13 and 218.75 +/- 50.88 
      min, respectively; P = 0.001 for both). In the POEM group, there were 
      improvements in all domains of the QoL questionnaire, whereas there were 
      improvements in only three domains in the LM-PF group. CONCLUSION: POEM and LM-PF 
      appear to be equally effective in controlling the symptoms of achalasia, 
      shortening LOS, and minimizing AEs. Nevertheless, POEM has the advantage of 
      improving all domains of QoL, and shortening anesthesia and procedure times but 
      with a significantly higher rate of gastroesophageal reflux.
CI  - (c)The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights 
      reserved.
FAU - de Moura, Eduardo Turiani Hourneaux
AU  - de Moura ETH
AD  - Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao 
      Paulo, Servico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSP, 
      Sao Paulo 05403-010, Brazil.
FAU - Jukemura, Jose
AU  - Jukemura J
AD  - Division of Esophageal Surgery, Hospital das Clinicas, University of Sao Paulo 
      School of Medicine, Sao Paulo 05403-010, Brazil.
FAU - Ribeiro, Igor Braga
AU  - Ribeiro IB
AD  - Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao 
      Paulo, Servico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSP, 
      Sao Paulo 05403-010, Brazil. igorbraga1@gmail.com.
FAU - Farias, Galileu Ferreira Ayala
AU  - Farias GFA
AD  - Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao 
      Paulo, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao 
      Paulo 05403-010, Brazil.
FAU - de Almeida Delgado, Aureo Augusto
AU  - de Almeida Delgado AA
AD  - Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao 
      Paulo, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao 
      Paulo 05403-010, Brazil.
FAU - Coutinho, Lara Meireles Azeredo
AU  - Coutinho LMA
AD  - Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao 
      Paulo, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao 
      Paulo 05403-010, Brazil.
FAU - de Moura, Diogo Turiani Hourneaux
AU  - de Moura DTH
AD  - Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao 
      Paulo, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao 
      Paulo 05403-010, Brazil.
FAU - Aissar Sallum, Rubens Antonio
AU  - Aissar Sallum RA
AD  - Division of Esophageal Surgery, Hospital das Clinicas, University of Sao Paulo 
      School of Medicine, Sao Paulo 05403-010, Brazil.
FAU - Nasi, Ary
AU  - Nasi A
AD  - Division of Esophageal Surgery, Hospital das Clinicas, University of Sao Paulo 
      School of Medicine, Sao Paulo 05403-010, Brazil.
FAU - Sanchez-Luna, Sergio A
AU  - Sanchez-Luna SA
AD  - Department of Internal Medicine, The University of Alabama at Birmingham Heersink 
      School of Medicine, Basil I. Hirschowitz Endoscopic Center of Excellence, 
      Division of Gastroenterology and Hepatology, Birmingham, AL 35233, United States.
FAU - Sakai, Paulo
AU  - Sakai P
AD  - Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao 
      Paulo, Servico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSP, 
      Sao Paulo 05403-010, Brazil.
FAU - de Moura, Eduardo Guimaraes Hourneaux
AU  - de Moura EGH
AD  - Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao 
      Paulo, Servico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSP, 
      Sao Paulo 05403-010, Brazil.
LA  - eng
PT  - Clinical Trial
PT  - Randomized Controlled Trial
PL  - United States
TA  - World J Gastroenterol
JT  - World journal of gastroenterology
JID - 100883448
RN  - 24GP945V5T (Barium)
SB  - IM
MH  - Adult
MH  - Barium
MH  - *Esophageal Achalasia/diagnosis/etiology/surgery
MH  - Esophageal Sphincter, Lower/surgery
MH  - *Esophagitis, Peptic/etiology
MH  - Esophagoscopy/adverse effects/methods
MH  - Fundoplication/adverse effects/methods
MH  - *Gastroesophageal Reflux/etiology
MH  - Humans
MH  - *Laparoscopy/adverse effects/methods
MH  - *Myotomy/adverse effects/methods
MH  - *Natural Orifice Endoscopic Surgery/adverse effects/methods
MH  - Quality of Life
MH  - Treatment Outcome
PMC - PMC9476850
OTO - NOTNLM
OT  - Deglutition disorders
OT  - Esophageal achalasia
OT  - Fundoplication
OT  - Gastroesophageal reflux
OT  - Heller myotomy
OT  - Randomized controlled trial
COIS- Conflict-of-interest statement: All the authors report no relevant conflicts of 
      interest for this article.
EDAT- 2022/09/27 06:00
MHDA- 2022/09/28 06:00
PMCR- 2022/09/07
CRDT- 2022/09/26 16:59
PHST- 2022/05/04 00:00 [received]
PHST- 2022/07/07 00:00 [revised]
PHST- 2022/08/06 00:00 [accepted]
PHST- 2022/09/26 16:59 [entrez]
PHST- 2022/09/27 06:00 [pubmed]
PHST- 2022/09/28 06:00 [medline]
PHST- 2022/09/07 00:00 [pmc-release]
AID - 10.3748/wjg.v28.i33.4875 [doi]
PST - ppublish
SO  - World J Gastroenterol. 2022 Sep 7;28(33):4875-4889. doi: 
      10.3748/wjg.v28.i33.4875.