Yaqi Zhai
Chinese PLA General Hospital, China
Title: What can a new endoscopic Ling classification do for achalasia?
Biography
Biography: Yaqi Zhai
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 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 â… , type â…¡(a,b,c), type â…¢. 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 â…¡c and â…¢. And LESP of these Typer â…¡c and â…¢ 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 â…¡c was showed to have the highest risk of complication and a modified POEM with short tunnel was demonstrated effectively by us.
