Résumé
Since 2010, POEM (per oral endoscopic myotomy) has taken a prominent place in the therapeutic arsenal of achalasia. This technique of myotomy of the lower esophageal sphincter can be performed according to several technical modalities, some of which have already been studied (different myotomy lengths, anterior vs. posterior approach). The objective of this study is to compare the impact of the depth of myotomy: selective internal (SIM) vs full thickness (FM) on the evolution of patients treated by POEM for achalasia.Methods: this was an observational, retrospective, bi-centric study in the University Hospital centers of Montpellier and Bordeaux. Patients were included between October 2018 and September 2022, then separated into two MSI vs MPE groups. The primary endpoint was clinical efficacy at 6 months. Secondary endpoints were postoperative parameters (pain defined by the need for stage 2 or 3 analgesics, length of hospital stay, complications) and GERD parameters (esophagitis at 6 months, pyrosis, pH-metry).Results: of the 166 patients who received POEM, 158 were included. 33 POEM and 125 MSI. Clinical efficacy rates at 6 and 12 months were 84 and 70% in the MSI group versus 90 and 80% in the MPE group (p=0.57 and p=0.74). The MPE group had a more frequent consumption of palliative analgesic 2/3 than in the MSI group (41 vs 21% p<0.01). The duration of hospitalization was longer in the MPE group than in the MSI group (2.17 (±2.62) vs 2.94 (±2.33), p<0.001). The rate of esophagitis at 6 months between the two groups was comparable (MSI 16% vs MPE 12% p=0.73). There was no difference in terms of pyrosis at 6 or 12 months between the MSI and MPE groups (18.5 vs 3.8% p=0.07 and 27 vs 12.5% p=0.35).Conclusion: there was no difference in our cohort between the two myotomy groups in terms of clinical efficacy and GERD. On the other hand, full thickness myotomy was associated with more postoperative pain and an increased length of hospital stay. Selective internal myotomy should be preferred to full thickness myotomy.