Yaqi Zhai

Yaqi Zhai

Chinese PLA General Hospital, China

Title: What can a new endoscopic Ling classification do for achalasia?


Yaqi Zhai, MD, chief doctor of department of Gastroenterology and Hepatology of Chinese PLA General Hospital, has completed his MD degree at the age of 26 years, from Chinese PLA medical school. He was dedicated to digestive endsocpic 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.


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 morderate term outcome.  We performed our first POEM in Oct 2010, and gradually found not all the achalasia patients were eligible and euqually safe to undergo POEM. Although achalasia had been staged or classified on radiography or manomentry, 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. Acorrding to presence of muti-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 evulate the clinical value of the achalasia. Patients with different Ling subtypes suffered the similar degree of symptoms according to Eckardt scores. Yet the Ling classfication 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 overal success rate of POEM was 97.7% within 1-year follow-up and there was no significant difference among different subtypes. Whereas Ling classficaiton 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.