| PART Ⅰ RESEARCH ON THE POST-POEM EFFICACY AND COMPLICATIONS OF A CHALASIAObjective: The objective of the research is to study the post-POEM efficacy of Achalasia and its complications by clinical follow-up visits and to find out the best methods of diagnosing post-POEM gastroesophageal reflux of Achalasia.Methods: Follow-up visits were conducted on the patients with Achalasia who received POEM treatment in our hospital from 2013 to 2015.Short-term complications after the operation were recorded,between 2 to 4 weeks after the operation Eckardt score was adopted to evaluate the operation efficacy,as well as the Gerd Q score,electronic gastroscopy and 24 Hours Esophagus Impedance-PH Monitoring to investigate the gastroesophageal reflux and the comparison of detection rate among the three different methods on post-POEM gastroesophageal reflux..Results: There were 78 patients with Achalasia who received POEM treatment in our hospital from 2013 to 2015,with 0 patients developed bleeding(0 / 78,0%),6 developed subcutaneous emphysema or pueumoperitoneum(6/78,7.69%),4 developed fever(4/ 78,5.13%),and 2 developed pneumonia after the operation(2/78,2.56%).76 patients’ post-operation Eckardt was lower than or equals 3(76/ 78,97.44%),2 patients were higher than or equals 4(2/78,2.56%).62 patients received Gerd Q scoring,which indicates that there are 11 patients with gastroesophageal reflux after the POEM(8/ 62,12.90%).56 patients received reexamination of gastricendoscopy after the POEM,the results of electronic gastroscope showed that there were 6 patients with reflux esophagitis(6/ 56,10.71%),including 4 A-grade reflux esophagitis(4/56,7.14%)and 2 B-grade reflux esophagitis(2/56,3.57%).After the POEM32 patients received 24 Hours Esophagus Impedance-PH Monitoring,the results showed that there were 6 patients with Esophageal pathological acid reflux(6/32,18.75%),12 patients with non-acid reflux at different levels(12/32,37.5%),and 1 patients with mix-reflux(1/32,3.13%),the total relevance ratio of reflux was 59.38%.Conclusion: The treating efficacy of POEM on Achalasia is high with few short-term complications,and the long-term complications of POEM are mainly gastroesophageal refluxes.24 Hours Esophagus Impedance-PH Monitoring is currently a method which enables us to most comprehensively analyze the nature of gastroesophageal reflux and guide the therapy,it has an inherent advantage over symptomatic scores and electronic gastroscopy.PART Ⅱ A STUDY OF 24 HOURS ESOPHAGUS IMPEDANCE-PH MONITORING’S EFFECTS ON THE EVALUATION OF POST-POEM GASTROESOPHAGEAL REFLUXObjective: This essay aims to study the gastroesophageal reflux after POEM for Achalasia patients by 24 Hours Esophagus Impedance-PH Monitoring so as to guide clinical therapy.Methods: By monitoring the 24 hours esophagus impedance-PH in 32 Achalasia patients after POEM,30 GERD patients and 15 healthy volunteers in our hospital(from 2013 to 2015),all the enrolled patients received 24 hours esophagus impedance-PH monitoring,and following parameters were recorded:PH values and properties of the reflux contents,height of reflux,duration of acid exposure,average duration of acid clearance,and correlations of reflux symptoms,etc.Between 2 to 4 weeks after the operation the Eckardt scoring was conducted to evaluate the therapeutic effects of POEM.Results: 32 Achalasia patients were enrolled,the follow-up time ranges from 1 to 20 months.30 patients’ postoperation Eckardt score were ≤3(30/3293.75%).among all the 32 post-POEM patients,6 patients experienced pathological acid-reflux(6/32,18.75%),12 patients experienced non-acid-reflux(12/32,37.5%),and 1 patients experienced both acid-reflux and non-acid-reflux(1/32,3.13%),the 2 patients whose Eckardt score is ≥4 suffered neither pathological acid-reflux nor non-acid-reflux(0/2,0%).30 GERD patients were enrolled,among all the 30 GERD patients,17 patients experienced pathological acid-reflux(17/30,56.67%),7 patients experienced non-acid-reflux(8/30,23.33%),and 6 patients experienced both acid-reflux and non-acid-reflux(6/30,20%).15 healthy volunteers were enrolled.The reflux of POEM group ranges7.06±4.49 cm and the range of GERD and healthy volunteers group is8.80±4.60cm、7.07±6.08 cm respectively,the difference between these three groups bears no statistic significance.The median of reflux and symptom correlation index SI,SSI and SAP of POEM group are all zero,whereas the median of SI,SSI and SAP of the GERD group are 14.68,1.72 and 76.28 respectively,and the SI,SSI and SAP of GERD group are apparently higher than those of POEM group,the differences bear statistic significance.The medians of acid exposure time and the average acid clearance time of the POEM group are0.2min and 2s respectively,whereas the medians of acid exposure time and the average acid clearance time of the GERD group are 49.9min and 23 s respectively,the differences bear statistic significance,the medians of acid exposure time and the average acid clearance time of the healthy volunteers group is 0.1min and 4s respectively,the difference between the post-POEM group and healthy volunteers group bears no statistic significance,whereas the difference between GERD group and the other two groups bears statistic significance.The acid-reflux were mainly non-fluid reflux and non-acid reflux were mainly fluid reflux,the difference is statistically significant.Conclusions: Non-acid-reflux is more common after POEM.24 Hours Esophagus Impedance-PH Monitoring,which can detect the symptoms-hidden acid-reflux and non-acid-reflux,is an efficient detection measure to diagnose gastroesophageal reflux in time after POEM.The result of 24 Hours Esophagus Impedance-PH Monitoring can guide therapy. |
