The Clinical Efficacy Of Peroral Endoscopic Myotomy In Treatment Of Achalasia

Objective:To investigate the clinical efficacy of peroral endoscopic myotomy(POEM) in treatment of achalasia(AC).Methods: Retrospectively study of clinical data which selected from 64 patients who diagnosed in Urumqi General Hospital of Lanzhou Military Region and received treatment of POEM from Feb. 2012 to Mar.2014. The Eckardt score and results of evaluation of esophageal manometry before and after surgery were observed.which 30 males,34 females,mean age 44.9 years, mean duration of 6.1 years; 42 cases of Han,Hui 9 cases, 9 cases of Uygur, Kazak 4 cases; BMI <18.5(underweight) 25 cases, 18.5~24.9(normal) 32 cases, more than 25(overweight) in 7 cases. Botox treatment had received 5 cases, 9 cases of stent or balloon angioplasty, surgery 5 cases. The clinical efficacy of patients before and after surgery Eckardt score and esophageal manometry power to judge the results of surgical treatment.Results: Sixty-three cases underwent surgery of POEM successfully, no major complication occurred,mean time of operation was(81.2±20.1)(30~120) min, submucosal tunnel incision length was(11.7±1.8)(10~15) cm, circular muscle incision length of long section was(9.2±0.8)(8.5~11) cm,the average length of the esophagus section(7.0±0.7)(6.5~8) cm, the average length of the stomach section(2.2±0.4)(2~3) cm; short section was(5.0±0.5)(4.5-6) cm.part of the length of the esophagus(2.9±0.2)(2.5~3) cm, the average length of the stomach section(2.1±0.4)(2~3) cm. Patients were followed up 56 cases(7 cases lost), follow-up of 12~36 months, mean 18.6 months after surgery except for one exception Branch(Chicago I class) patients, 55 cases of dysphagia in patients without recurrence, eating well, no chest pain and significant reflux phenomenon, surgical curative effect. Clinical success was achieved in 56 patients at 12~36month follow-up Eckardt Score from 7.0 to 1.4(P <0.01). Twenty-three cases of lower oesophageal sphincter pressure decreased from 50.6 to 18.7 mm Hg(P <0.01). The clinical effect is was significant. Follow-up Long(thirty-five cases), short(twenty-one cases) circular cut of the clinical efficacy and Eckardt score had no difference(P’> 0.05).Conclusion:POEM as a new minimally invasive techniques is safety and efficacy in the treatment of AC,long-term efficacy and complications of POEM remains to be large sample follow-up and observation.