Journal of Gastrointestinal & Digestive System
Open Access

Abstract

Peroral Endoscopic Myotomy (POEM) is a new minimally-invasive endoscopic method for achalasia, being expected to be the first treatment choice with satisfactory short and moderate term outcome. We performed our first POEM in Oct 2010, and gradually found not all the achalasia patients were eligible and equally safe to undergo POEM. Although achalasia had been staged or classified on radiography or manometry, there was no endoscopic classification. We retrospectively analyzed the endoscopic features of 976 achalasia patients in our endoscopic center and proposed a new endoscopic Ling classification. According to presence of multi-ring, crescent-like structure and diverticulum, achalasia was divided into three subtypes: type I, type II (a,b,c), type III. Then prospective study enrolling 341 patients with POEM was performed to evaluate the clinical value of the achalasia. Patients with different Ling subtypes suffered the similar degree of symptoms according to Eckardt scores. Yet the Ling classification had significant correlation with symptom duration and lower esophageal sphincter pressure (LESP). The patients with longer duration were more likely to developed Typer IIc and III and LESP of these Typer IIc and III patients was obviously lower than the others. The overall success rate of POEM was 97.7% within 1-year follow-up and there was no significant difference among different subtypes, whereas Ling classification had significant correlation with complications, such as gas-related adverse and mucosal perforation. Ling IIc was showed to have the highest risk of complication and a modified POEM with short tunnel was demonstrated effectively by us.

Biography

Yaqi Zhai is a Chief Doctor of Department of Gastroenterology and Hepatology of Chinese PLA General Hospital, completed his MD degree from Chinese PLA Medical School. He was dedicated to digestive endoscopic tunnel technique and had published more than 10 papers in reputed journals. He was also a Member of academic group of Capsule Endoscopy and Enteroscopy of CSGE