Ling classification applied in the preoperative safety and effectiveness assessment of POEM

At present, peroral endoscopic myotomy (POEM) has been considered as the recommended treatment for achalasia, as it causes trauma to a smaller area and has fewer short-term serious complications than other treatments. However, due to the different morphology of esophagus, not all the patients with achalasia are eligible to receive POEM surgery. And the purpose of our study was to apply Ling classification, which proser Linghu put forward in 2011, in the preoperative assessment of POEM, expecting to reduce the occurrence rate of complications during or post-POEM. The clinical data of 341 achalasia patients were collected and classified, according to the endoscopic pictures related to the middle and the lower parts of the esophagus. The correlation between Ling classification and LESP or Eckardt score was analyzed for the efficiency estimation, and the correlation of Ling classification and incidence of complications was counted for the safety evaluation. Ling classification was correlated with the LESP of 95 patients and Eckardt score of 131 patients. Compared to preoperative data, post-POEM LESP and Eckardt score both decreased significantly in all types of Ling classification (p < 0.05), while no significant difference in the decrease degree of either LESP or Eckardt score was found among different types of Ling classification (p > 0.05). This means Ling classification may not directly affect the postoperative efficacy of POEM. By analyzing the correlation between Ling classification and intraoperative complications, we found that the differences of total complications, gas-related complication and mucosal injury were all significant among all types of Ling classification (p < 0.05). Ling classification can be applied in the preoperative assessment of the safety and efficacy of POEM, and it might provide a guideline for how to reduce the complications during POEM surgery.