| ObjectivesTo observe the changes of symptoms and esophageal motility after peroral endoscopic myotomy(POEM)in patients with achalasia(AC),to evaluate the clinical outcome of POEM for AC,and to analyze whether manometric subtype is associated with treatment outcome of POEM in AC.MethodsA total of 46 patients with achalasia who met the inclusion criteria were enrolled in our study and categorized into two subtypes based on high-resolution manometry(HRM),12 type I,34 type II,and no type III patients.We collect preoperative Eckardt score,HRM metrics,operative data,postoperative complications retrospectively.Eckardt score and HRM were performed at 1 months,at least 6 months after POEM to complete follow-up data.Statistical analysis were carried out with SPSS 24.0 statistical package.Results1.POEM was successfully performed in all patients.The overall incidence of postoperative complications requiring intervention was 19.6%,which improved after conservative treatment.2.The Eckardt score of all patients at a mean follow-up of 1 month,23.75 months after POEM were 1.46±1.57 and 1.96±2.01,respectively,and the differences was statistically significant(P<0.01),and compared with that of pre-operation 7.63 ± 2.00,both are significantly reduced(P<0.01).3.Patients showed a significant improvement in post-POEM four seconds integrated relaxation pressure(4sIRP)、lower esophageal sphincter pressure(LESP)、lower esophageal sphincter residual pressure(LESRP)、lower esophageal sphincter relaxation rate(LESRR)at a median follow-up of 29 months [pre-vs post-treatment,17.8(9.9,24.4)vs 9.3(5.3,17.9),P<0.05;22.3(5.31,17.9)vs 12.3(9.6,21.0),P<0.05;25.0(18.0,41.0)vs 12.0(7.0,20.0),P<0.01;-8.0%(-30.0%,14.0%)vs 19.0%(-4.0%,24.0%),P<0.05,respectively].Upper esophageal sphincter pressure(UESP),upper esophageal sphincter residual pressure(UESRP)and lower esophageal sphincter length(LESL)had no significant difference before and after operation(P > 0.05).4.In type I group,the differences in Eckardt score between before operation and at a mean follow-up of 1 month,23.75 months after operation were statistically significant(8.25±1.49,0.83±1.19,1.33±1.23,respectively,P<0.05),and the differences in Eckardt score between the above two follow-up times were also significant(P<0.05).However,4sIRP,LESP,LESRP,LESRR had no significant difference before and after operation in type I group(P > 0.05).5.In type II group,significant difference was found among Eckardt scores before POEM,at a mean follow-up of 1 month,23.75 months(7.41±2.13,1.68±1.65 and 2.18±2.20,.P<0.05,respectively).In addition,POEM decreased the 4sIRP [from 20.2(13.0,27.1)to 10.0(5.7,16.7),P<0.05],LESP [from 27.7(17.0,35.4)to 12.2(9.2,24.8),P<0.05],LESRP [from 25.0(18.5,49.3)to 11.0(6.25,18.8),P<0.01],LESRR [from-9.5%(-33.8%,26.5%)to 21.0%(10.3%,30.8%),P<0.05] at a median follow-up of 29 months.6.No difference was found in pre-POEM Eckardt score,LESP,LESRP and 4sIRP between the type I and type II groups(P > 0.05).So were post-POEM and changes of above metrics.7.There were no significant differences in procedure time,total myotomy length,postoperative hospital stay,preoperative Eckardt score,postoperative Eckardt score,therapeutic success between the previously treated and treatment native patient(P > 0.05).ConclusionsPOEM can effectively reduce the pressure of LES,then significantly alleviate the symptoms such as dysphagia in AC patients.In other words,the short and intermediate-term outcome of POEM for achalasia was excellent,but the efficacy of POEM decreases slightly with time;The success rate was similar between achalasia type I and type II;LES metrics such as 4sIRP,LESP,LESRP and LESRR had no significant difference after POEM in type I achalasia patients,while those in type II patients were significantly improved;POEM has no effect on the indicators related to upper esophageal sphincter. |
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