BACKGROUND: Peroral endoscopic myotomy (POEM) has been described as a novel treatment for @entity1318 . Owing to its technical difficulty, POEM is not widely performed. This study was aimed to prospectively assess the factor predicting technical difficulty of POEM in a single center with large volume cases. METHODS: A total of 105 cases of @entity1318 treated by POEM from April 2011 to September 2014 were analyzed. Difficult cases of POEM were defined as procedure time >= 90  min and occurrence of adverse events, including mucosal perforation, pneumothorax, and major @entity548 . Univariate and multivariate logistic regression analyses were performed to assess the predictive factors of difficult POEM. RESULTS: POEM was successfully completed in all the @entity1 , and no one was converted to laparoscopy. The number of cases with procedure time >= 90  min was 17. Mucosal perforations occurred in six (5.7  %) @entity1 during submucosal tunnel creation, major @entity548 occurred in seven (6.7  %) @entity1 , and pneumothorax occurred in six (5.7  %) @entity1 immediately after procedure. All the complications were managed conservatively. No other intraoperative and immediate @entity260 , including infections and @entity516 , occurred. Multivariate analysis showed that early period (odds ratio [OR] 4.173, 95  % confidence interval [95  % CI] 1.36-6.829, P  =  0.023) and triangular tip knife ([OR] 6.712, [95  % CI] 1.479-30.460, P  =  0.014) were independent factors associated with technical difficulty regarding longer procedure time (procedure time >= 90  min). CONCLUSION: POEM is safe for the treatment of @entity1318 . Triangular tip knife and early period were independent risk factors for longer procedural time.

Factors predicting the technical difficulty of peroral endoscopic myotomy for XXXX .

@entity1318 :: ('MESH:D004931', 'Disease') :: ['achalasia', 'esophageal achalasia'] @entity1 :: ('9606', 'Species') :: ['patients'] @entity548 :: ('MESH:D006470', 'Disease') :: ['bleeding'] @entity260 :: ('MESH:D011183', 'Disease') :: ['postoperative complications'] @entity516 :: ('MESH:D011027', 'Disease') :: ['pneumoperitoneum']
@entity1318 :: (MESH:D004931,Disease) :: ['achalasia']
