| Background and aim: Peroral endoscopic myotomy(POEM)is a kind of endoscopic minimally invasive selective myotomy.Due to its advantages of good efficacy and high safety,it has gradually become a treatment for achalasia(Achalasia,AC).This study evaluated the long-term efficacy and complications of POEM surgery in our hospital for the treatment of achalasia,and comparatively analyzed the postoperative efficacy and complications of long course and short course.Methods: A retrospective analysis of 84 patients who were diagnosed with AC at the First Affiliated Hospital of Dalian Medical University from January 2013 to September 2019,and met the study criteria according to the inclusion criteria and exclusion criteria,including a total of 26 patients more than 5 years after surgery.Before operation,79 patients completed gastroscopy,73 patients completed esophageal manometry,and 84 patients completed Eckardt score.43 cases were reviewed for gastroscopy after operation,including 19 cases for gastroscopy within 1 year and 15 cases for gastroscopy for more than 5 years.18 patients were reviewed for esophageal manometry after operation,including 6 patients who were reviewed for esophageal manometry within 1 year,and 8 patients who were reviewed for more than 5 years after surgery.The efficacy,postoperative reflux and recurrence of patients were evaluated within 1 year and 5 years after operation.Eckardt score and esophageal manometry were used to evaluate the efficacy.Gerd Q scale and gastroscopy were used to evaluate postoperative reflux.Postoperative recurrence diagnosis relied on Eckardt score combined with gastroscopy and esophagus manometry.Compare the effects of POEM operation on postoperative efficacy and complications of patients with different courses.SPSS 21.0 statistical software was used for data analysis.Result:General situation: The 84 patients who met this study were 38 males(45%)and 46 females(55%).The age range is(15-81)years old,the average age is(47.61±15.17)years old,the median age is 46.5 years old,and the median course of disease is 5 years.?.Analysis of short-term efficacy and recent complications:1.Short-term efficacy after operation:Eckardt score: 83 cases were effective within 1 year after operation(Eckardt ?3),and the clinical remission rate was 97.6%(83/84).Within 1 year after the operation,84 patients were reduced from preoperative(6.81±1.57)points to postoperative(1.65±0.81)points,the difference was statistically significant(P<0.001).HRM: 6 cases of esophageal pressure measurement were reviewed within 1 year after operation.The preoperative and postoperative pressure measurements of 6 patients were compared.The preoperative LES resting pressure(26.35±5.89)mm Hg,postoperative LES resting pressure(16.50 ±5.96)mm Hg,the difference was statistically significant(P<0.001).The residual pressure of LES before operation(21.28±6.04)mm Hg,and the residual pressure of LES after operation(9.15±3.72)mm Hg,the difference was statistically significant(P<0.001).2.Recent postoperative reflux rate and recurrence:Postoperative reflux: 20 patients had reflux symptoms within 1 year after surgery,and the incidence of reflux symptoms was 23.8%(20/84).Within 1 year after operation,19 patients had gastroscopy re-examination,of which 8 cases were diagnosed with esophagitis,and 8 cases had reflux symptoms.Recurrence: 1 case relapsed within 1 year after operation,the recurrence rate was 1.2%(1/84).??Analysis of long-term efficacy and long-term complications of patients more than 5 years after surgery:1.Long-term efficacy analysis:Eckardt score: 22 cases were effective after 5 years of operation(Eckardt ?3),and the clinical remission rate was 84.6%(22/26)after 5 years.More than 5 years after the operation,26 patients had decreased from preoperative(6.88±1.73)points to postoperative(2.65±0.94)points,the difference was statistically significant(P<0.001).HRM: 8 cases of esophageal pressure measurement were reviewed more than 5 years after operation.The comparison of preoperative and postoperative pressure measurement values in 8 patients.The preoperative LES resting pressure(31.13±5.69)mm Hg,postoperative LES resting pressure(12.33±10.06)mm Hg,the difference is statistically significant(P<0.001).The residual pressure of LES(16.94±7.93)mm Hg before operation and the residual pressure of LES(6.03±5.77)mm Hg after operation were statistically significant(P<0.001).2.Long-term postoperative reflux rate and recurrence:Postoperative reflux: There were 26 patients with ?5 years postoperatively,9 patients had reflux symptoms,and the incidence of reflux was 34.6%(9/26).A total of 15 patients were reviewed for gastroscopy more than 5 years after the operation.9 patients were diagnosed with esophagitis,and 9 patients with Gerd Q symptom scale all indicated reflux symptoms.Recurrence: A total of 5 persons were considered to relapse,with a relapse rate of 19.23%(5/26).??The comparison of short-term and long-term efficacy and concurrent reflux symptoms after POEM:1.Short-term and long-term efficacy comparison after operation:26 patients more than 5 years after the operation were self-controlled,and paired T test was used to compare the postoperative Eckardt score to judge the efficacy.26 patients had Eckardt score(1.50±0.86)within 1 year after operation and Eckardt score(2.65±0.94)more than 5 years after operation.The difference between the two groups was statistically significant(P<0.001).2.Comparison of short-term and long-term postoperative reflux symptoms and recurrence rate:26 patients who were more than 5 years after the operation were compared with themselves,and the incidence of short-term and long-term reflux symptoms was compared.Among the 26 patients,3 patients had reflux symptoms within 1 year after operation,and the incidence of reflux symptoms was 11.5%(3/26).9 patients had reflux symptoms more than 5 years after surgery,and the incidence of reflux was 34.6%(9/26),the difference is statistically significant(P=0.048).??The impact of POEM surgery on postoperative efficacy and complications of patients with different courses of disease:1.A total of 84 patients in this study were included in the investigation of postoperative efficacy and complications of different courses of disease.The average median course of disease was 5 years.With reference to the median course of disease,comparing the group with a course of >5 years with a course of ?5 years,the efficacy analysis: The Eckardt score(2.06±0.81)in the group with a course of more than 5 years after surgery,and Eckardt score(1.43±0.84)in the group with a disease course of ?5 years,The difference between the two groups is statistically significant(P=0.001).Postoperative reflux rate: the disease duration> 5 years group occurred postoperative reflux symptoms accounted for 48.4%(15/31)of the group,and the disease duration ? 5 years group occurred postoperative reflux symptoms accounted for 26.4%(14/53)of the whole group.The difference between the groups was statistically significant(P=0.041).There was no statistical difference between the two groups in gender,age,preoperative Eckardt score(P=0.642,0.091,0.198).2.To further explore the best time for postoperative efficacy:Patients with a course of ?5 years were grouped at intervals of 1 year,that is,a course of <1 year group,1?<2 year group,2?<3 year group,3?<4 year group,4??5 year group.The Eckardt scores of the postoperative efficacy of each group were(1.06±0.77),(1.07±0.47),(1.75±0.46),(1.88±0.64),(2.00±0.58),The variance between groups was statistically significant(P=0.001).Postoperative reflux symptoms in each group accounted for 25.0%(4/16),21.4%(3/14),37.5%(2/8),37.5%(3/8),28.6%(2 /7),the difference between the groups was not statistically significant(P=0.967).There was no statistically significant difference in gender,age,and preoperative Eckardt score between groups(P =0.203,0.212,and 0.231,respectively).After multiple analysis of efficacy,the course of disease was less than 1 year group and 1 to <2 years group.The Eckardt scores were(1.06±0.77)and(1.07±0.47)respectively,and there was no statistically significant difference between the groups(P=0.970).Three groups of data from 2 to <3 years,3 to <4 years,and 4 to ? 5 years were consecutively included in the group.Postoperative Eckardt scores were(1.75±0.46),(1.88±0.64),(2.00±0.58)The difference between the groups was not statistically significant(P=0.611).Comparing the group with a disease course of less than 2 years and the 2 to 5 years group,there was no statistically significant difference in gender,age,and preoperative Eckardt score between the two groups(P =0.933,0.918,0.319),Postoperative Eckardt scores of the two groups were(1.13±0.57)and(1.98±0.71),and the difference was statistically significant(P=0.000).Further comparing the group with less than 2 years of disease and the group with more than 2 years of disease,there was no statistically significant difference in gender,age,preoperative Eckardt score between the two groups(P = 0.845,0.454,0.266).Postoperative Eckardt scores of the two groups were(1.13±0.57)and(1.98±0.71),The Eckardt scores of the two groups were statistically significant(P=0.000).Conclusion:1.POEM surgery has significant effects on patients with achalasia,both short-term(within 1 year)and long-term(within 5 years).However,with the increase of postoperative years,there may be a trend of decreasing efficacy and increasing relapse rate.2.With the increase of POEM postoperative years,reflux complications may increase.3.Patients with achalasia with a course of less than 2 years may be the best time for POEM surgery. |
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