Abstract
Per oral endoscopic myotomy (POEM) has become the treatment of choice in many specialized centers for the management of achalasia. The objective of this study is to evaluate and compare the optimization of the procedure by performing a transverse mucosotomy versus a longitudinal mucosotomy.
A retrospective cohort study was conducted on patients who underwent POEM at our institution. Patients were divided into 2 groups based on the type of mucosotomy performed: transverse (Group 1) and longitudinal (Group 2). The study evaluated the time taken to complete the mucosotomy and enter the submucosal tunnel, the time to close the tunnel, and the number of clips used in each group. Results were compared using SPSS and Student’s t-test.
A total of 32 patients were analyzed, with 16 patients in each group. Group 1 had a significantly shorter time to enter the submucosal tunnel (mean time 180 seconds, SD: 153 seconds, R [90-640]) compared to Group 2 (mean time 360 seconds, SD: 147 seconds, R [120-600]; P < .001 [95]). Group 1 also had a significantly shorter time to close the submucosal tunnel (mean time 216 seconds, SD: 93 seconds, R [90-395]) compared to Group 2 (mean time 543 seconds, SD: 114 seconds, R [345-695]; P < .001 [95]). Additionally, Group 1 used significantly fewer clips for closure (mean clips used 3 clips, SD 0.65 clips, R [2-4]) compared to Group 2 (mean clips used 6 clips, SD 1.36 clips, R [4-8]; P < .001 [95]).
Based on the results, transverse mucosotomy in POEM may be more efficient than longitudinal mucosotomy. Transverse mucosotomy significantly reduced time to enter the submucosal tunnel, time for tunnel closure, and clips needed for closure. The limitation of this study is that patients were not randomized to either group. All patients were treated after the learning curve of 100 cases.