Peroral Endoscopic Myotomy (POEM) For The Treatment Of Achalasia Treatment And Follow-up Of20Cases

Background:Achalasia of cardia (AC) is a kind of unknown etiology of lower esophageal sphincter (LES) movement disorders, for the main characteristics of it is lower esophageal sphincter relaxation after swallowing disorder, so that food can not pass into the stomach, then there can appear a series of symptoms produced by retention. The main symptoms of achalasia are dysphagia, regurgitation and vomiting, pain or discomfort in the chest. The majority of patients have symptoms for a long time before medical treatment, ranging from a few days to years. At the beginning of the symptoms may not be obvious, and then slow progress, but also can happen suddenly, even asymptomatic, only occasionally found that routine chest X-ray examination and inspection of the respiratory tract. At present, the treatment of AC is almostly with open surgical oesophagoscope and endoscopic dilatation treatment. Botox injections Esophagus stent implantation and so on. These methods with high cost, big pain, complications, not the long-term remission of disease etc. Peroral endoscopic myotomy (POEM) is a method of Japanese scholar Inoue, reported in2010, which is a new treatment for cardiac achalasia. Nearly2years, POEM developed rapidly in China, research report shows good short-term effect. Object:To study recent efficacy and complications of the Peroral endoscopic myotomy (POEM) in treatment of achalasia retardation.Methods:In2012January, to2013March,20in hospitalized patients with clinical manifestations, on the basis of esophageal radiography confirmed achalasia with the treatment of POEM technology. The oldest patient is65years old, the smallest patient is15years old, the average age is38.50years old. The longest course is20years, the shortest is1year, the average duration of5.83years. POEM operation steps are as follows:(1) separated from the esophageal mucosa layer;(2) separating the submucosa, establishment of submucosae "tunnel";(3) endoscopic incision of the circular muscle;(4) close the mucosal incision by titanium clip. Statistical and analytical operation time, operative complications, hospitalization expenses, hospitalization time. Follow-up observation of patients were observed after operation, effect.Results:This group of20patients with achalasia was gave POEM treatment in the operation room, completed under general anesthesia. All the operations are operating smoothly. The operative time was85min～280min.Mean operative time was143.5min.1patient was with pneumothorax, healed after closed drainage of the pleural cavity. Five patients had mediastinal and subcutaneous emphysema, quickly absorbed after surgery. After surgery,7cases were of fever. There were no cases of delayed bleeding, esophageal leak of the mediastinum, chest infections and other complications. Length of stay up to16days, at least4days, average length of stay was6.95days. Patients after operation for1-month,6-month and12-month follow-up and telephone follow-up. The longest follow-up period was12months, the shortest1months. After1month of symptom relief rate was95%(19/20).6months after remission rate was92.8%(13/14).Conclusions:Short-term follow-up proved that the POEM technique in the treatment of achalasia is safe, high efficiency. But the POEM still has some complications occurrence rate. Skilled endoscopic operative techniques can reduce the incidence of complications. There is no significant correlation between surgical complications and efficacy. Long course of disease, gastric circular muscle thickening can lead to serious complications, a longer operation time, longerhospitalization time and higher cost.