Objective        To compare the clinical efficacy of circular myotomy and full-thickness myotomy guided by peroral endoscopy in treatment of incision length of ≤5 cm and of 5 cm in achalasia patients.       Methods        Clinical data of 56 achalasia patients who were treated with peroral endoscopic myotomy (POEM) in our hospital from February 2013 to August 2014 were collected and then retrospectively analyzed in this study. Twenty-four of them received circular myotomy and were assigned in the circular myotomy group

and other 32 patients undergoing full-thickness myotomy in the full-thickness myotomy group. Twenty-eight patients who received incision length of ≤5 cm were in the short-myotomy group

and the other 28 patients with myotomy incision length 5 cm were in the long-myotomy group. Esophageal diameters before and after operation

and intra- and post-operative incidences of complications were compared among the above 4 groups.       Results       Before the treatment

there were no significant differences in sex

age

body mass index

Eckardt score

esophageal diameter and illness course among the patients from 4 groups (P0.05). Significant differences were seen in the changes of preoperative Eckardt scores in 1

6 and 12 months postoperatively in the 4 groups (P0.05). When the full-thickness myotomy group was compared with circular myotomy group

there was no significant differences in Eckardt scores in postoperative 1 (0.50±1.07 vs 0.71±1.04)

6 (0.53±1.10 vs 0.50±0.78)

and 12 months (0.37±0.75 vs 0.42±0.82)

esophageal diameter in 6 months postoperatively (26.44±7.88 vs 24.00±5.82 mm)

gas complications (5/24 vs 13/32

all P0.05). When the short-myotomy group was compared with long-myotomy group

no significant differences were found in Eckardt scores in 1(0.46±0.83 vs 0.71±1.42)

6(0.39±0.68 vs 0.64±1.19)

and 12 months postoperatively (0.32±0.72 vs 0.46±0.84)

esophageal diameter in 6 months (24.81±7.87 vs 25.98±6.37 mm)

and gas complications (9/28 vs 9/28

all P0.05).       Conclusion       POEM is recommended for the treatment of achalasia

and circular myotomy and incision length of ≤5 cm are better.