| Background and Aim:Achalasia is a primary esophageal disease.The main clinical symptoms including :dysphagia,retrosternal pain,undigested food reflux and cough or lung infection induced by food regurgitation.The pathogenesis of achalasia is still not completely clear,which is probably related to virus infection,psychological factors,neurological factors,genetics et al.Cause esophageal sphincter relaxation function impaired,so the main purpose of existing treatment is to solve the obstruction.Peroral endoscopic myotomy(POEM)is an endoscopic surgery,and have recieved extensive application at home and abroad for its minimally invasive and short-term success treatment rate.Meanwhile,it also causes a series of complications,and whether it has higher incidence of gastroesophageal reflux is still controversial.The recent researchs on POEM are short of the detailed report and analysis,and long-term complications after the operation is also shortage.This study aims to assess the operation effection by using Eckardt symptoms scale,SF-36 health survey and esophageal manometry.In addition,we analyse the postoperative complications.At the same time,we assess the postoperative reflux by the RDQ,endoscopy and esophageal 24 hours pH monitoring,from subjective and objective aspects.From above aspcets,we can have an objective understanding for poem,and provide a reference for reduce the incidence of related-complications.Methods:Collected 33 achalasia patients who treated by Per-oral endoscopicmyotomy(POEM)in the First Affiliated Hospital of DaLian Medical University from January 2013 to March 2015,5 cases lost follow-up.Postoperative observation(more than 1 year):(1)Effeciency evaluation: Eckardt score was uesd to know the postoperative clinical symptoms by telephone;SF-36 health questionnaire was used to understand the quality of life of patients before and after surgery;Esophageal manometry was uesd to know the esophageal motility changes in 11 patients.(2)Postoperative complications: Collected 28 patients history when admitted to hospital,then analyzed the incidence of postoperative complications.By follow-up,28 patients were asked RDQ.Underwent gastroscopy to know if the patients had esophagitis.Some patients were examed with 24-hour esophageal pH monitoring to know if had pathological acid reflux.Through checked the above comprehensive evaluations,we want know the postoperative gastroesophageal reflux.SPSS20.0statistical software was used for analysis processing of above experimental data.(x±s)and t test was used for measurement data;Count data expressed with ratio,chi square test(Fisher exact test)was uesd for difference test.If p < 0.05,the difference was statistically significant.Result:1.General(18M,10F).Age is 17-76 years old,an average age of 45 years old,Body mass index(BMI): 6 cases were low weight,19 cases were normal weight,2cases were overweight,1case were obesity;Disease duration was 3-480 months,the median duration is 7 months.Diet: 17 cases favored spicy food;6 cases had a history of smoking;8 cases had drinking history;Esophageal manometry: 16 cases were type I,12 cases were type II,no cases were type III;6 patients treated by carnitine or balloon dilation before POEM.Operation time was 88.57 + 26.31 min,muscle incision length9.57 + 1.79 cm,and tunnel length 12.36 + 1.13 cm.2.Efficiency analysis: 28 patients were followed up,and follow-up time was 12-26 months.27 cases treated by POEM successfully,failure in 1 case,and the effective rate was 96.4%.The postoperative Eckardt scores were significantly decreased(P<0.001).The SF-36 score was higher than preoperative(P<0.001).11 cases completed the esophageal manometry,showing that LES resting pressure was significantlydecreased(P<0.001).Postoperative relaxation of LES pressure was significantly decreased(P<0.001).3.Postoperative complications: Near-term complications: 3 cases had pneumothorax,5 cases had pneumoperitoneum,6 cases had pneumomediastinum,4 cases had subcutaneous emphysema,the total gas-related complications occurred in 10 cases.20 cases had pleural effusion,no cases had perforation,4 cases had pneumonia,1 cases had bleeding,8 cases had fever.After more than one year,by follow-up,we asked patients if they had symptoms related to the complications,such as recurrent cough,fever,shortness of breath,chest pain,hematemesis and melena,the results were shown that patients without these symptoms.After 1 year,7 patients undertook thoracic CT,without the symptom of CT findings,and 14 postoperative patients with gastroscopy showed a surgical incision mucosa healed well.No perforation occurred.Long-term complications:28 cases were followed up,4 patients were diagnosed reflux according to RDQ.14 patients underwent gastroscopy,5 patients were diagnosed esophagitis,and 2 of them had Reflux symptom at sametime.28 patients were divided into Reflux group(n=4)and non-Reflux group(n=24).The general data and operation data of the two groups were statistically analyzed.The results showed that there was no significant difference between the two groups.According to gastroscopy,the 14 patients were divided into two groups,esophagitis group and non-esophagitis group.Preoperative LES resting pressure of non-esophagitis group was higher than esophagitis group's,(P < 0.05).The remaining variables had no statistical difference.4 patients underwent esophageal 24 hours PH monitoring,the results showed that 2 patients had acid reflux,of which,one patient with Reflux symptom,the other without reflux symptom.Conclusion1.From 1 year observation,the clinical symptoms,quality of life and esophageal motility has been significantly improved.2.POEM can cause Gas-related complications,but it is more common not severe.Although some complications,such as,bleeding,perforation are more serious,theincidence is lower or none.POEM could induce gastroesophageal reflux,some patients without reflux symptom also occure pathological reflux in reality. |
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