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Background and aims <p>The sigmoid-type achalasia is an advanced stage of achalasia characterized by severe dilatation, tortuous angulation, and rotation of the esophageal body. Our aim is to explore the safety, and efficacy of peroral endoscopic myotomy (POEM) for sigmoid-type achalasia.</p> Materials and methods <p>A total of 78 patients who underwent POEM for sigmoid-type achalasia were retrospectively included. The primary outcome was clinical success, defined as a postoperative Eckardt score ≤ 3 points. Secondary outcomes were perioperative adverse events (AEs), and procedure-related parameters.</p> Results <p>The mean pre-POEM Eckardt score was 7.3 ± 2.0 and 52 patients (66.7%) had a disease duration of ≥ 10&#xa0;years. S1 type was found in 62 patients and S2 type in 16 patients. The technical success rate was 100%. The mean procedure duration was 80.4 ± 40.5&#xa0;min and the mean hospital stay was 2.9 ± 1.7&#xa0;days. Intraoperative mucosal injury occurred in 18 (23.1%) patients, including 14 (17.9%) type I and 4 (5.1%) type II. All mucosal injury were clipped and did not induce any complications. CT revealed gas-related AEs in 7 cases (9.0%), pleural effusions in 10 cases (12.8%), pneumonitis in 10 cases (12.8%), and focal atelectasis in 6 cases (7.7%). The above AEs only appear on CT scans, are asymptomatic, and do not require intervention. Major AEs were found in 1 patient. This patient developed a postoperative pleural effusion that required drainage. The clinical failure rate at 2-year, 5-year, and 10-year follow-up visits were 1.3%, 12.8%, and 42.5%, respectively. There were no significant differences between type S1 and S2 achalasia in terms of procedure-related parameters, AEs and clinical failure rates.</p> Conclusions <p>POEM is a safe and effective procedure for sigmoid-type achalasia at the 2-year and 5-year follow-up visits. However, a significant rate of clinical failure was observed at 10&#xa0;years, highlighting that long-term durability remains a concern in managing this advanced disease stage. Clinical outcomes were similar for both S1 and S2 types of achalasia.</p> Graphical abstract <p></p>

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Long-term outcome of peroral endoscopic myotomy for sigmoid-type achalasia: S1 vs S2 subtypes

  • 期刊论文

  • 发表日期：

    2025年11月7日

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  • Peirong Xu,
  • Zuqiang Liu,
  • Yanfang Tan,
  • Yicheng Tian,
  • Hao Hu,
  • Quanlin Li,
  • Pinghong Zhou

摘要

Background and aims

The sigmoid-type achalasia is an advanced stage of achalasia characterized by severe dilatation, tortuous angulation, and rotation of the esophageal body. Our aim is to explore the safety, and efficacy of peroral endoscopic myotomy (POEM) for sigmoid-type achalasia.

Materials and methods

A total of 78 patients who underwent POEM for sigmoid-type achalasia were retrospectively included. The primary outcome was clinical success, defined as a postoperative Eckardt score ≤ 3 points. Secondary outcomes were perioperative adverse events (AEs), and procedure-related parameters.

Results

The mean pre-POEM Eckardt score was 7.3 ± 2.0 and 52 patients (66.7%) had a disease duration of ≥ 10 years. S1 type was found in 62 patients and S2 type in 16 patients. The technical success rate was 100%. The mean procedure duration was 80.4 ± 40.5 min and the mean hospital stay was 2.9 ± 1.7 days. Intraoperative mucosal injury occurred in 18 (23.1%) patients, including 14 (17.9%) type I and 4 (5.1%) type II. All mucosal injury were clipped and did not induce any complications. CT revealed gas-related AEs in 7 cases (9.0%), pleural effusions in 10 cases (12.8%), pneumonitis in 10 cases (12.8%), and focal atelectasis in 6 cases (7.7%). The above AEs only appear on CT scans, are asymptomatic, and do not require intervention. Major AEs were found in 1 patient. This patient developed a postoperative pleural effusion that required drainage. The clinical failure rate at 2-year, 5-year, and 10-year follow-up visits were 1.3%, 12.8%, and 42.5%, respectively. There were no significant differences between type S1 and S2 achalasia in terms of procedure-related parameters, AEs and clinical failure rates.

Conclusions

POEM is a safe and effective procedure for sigmoid-type achalasia at the 2-year and 5-year follow-up visits. However, a significant rate of clinical failure was observed at 10 years, highlighting that long-term durability remains a concern in managing this advanced disease stage. Clinical outcomes were similar for both S1 and S2 types of achalasia.

Graphical abstract