| Objective:The peristalsis of esophageal body in patients with achalasia may be partially recovered after peroral endoscopic myotomy（POEM）,but its prediction and influencing factors remain unclear.The purpose of this study is to evaluate the changes of esophageal motility patterns related to potential peristaltic recovery after POEM,and to analyze the possible predictors and their clinical relevance.Methods:A retrospective analysis was performed on patients diagnosed with achalasia and receiving the first POEM treatment from March 2012 to March 2021.High-resolution esophageal manometry（HREM）and clinical symptom assessment were performed before and after POEM.The changes of esophageal motility patterns and HREM related parameters before and after POEM were compared according to the latest Chicago classification version4.0（CCv4.0）.Results:1.81 patients were enrolled in the group,including 28 males and 53 females,with a mean age of（44.70±14.94）years.The median preoperative course of disease was 3 years（range 0.33-40 years）.The median follow-up time of patients after POEM was 11 months（range 6.3-25.8 months）.There were no signs of peristaltic contraction before POEM.All the cases were divided into three subtypes before POEM according to the HREM CCv4.0,including 31（38.3%）Achalasia Type Ⅰ,46（56.8%）Type Ⅱ,4（4.9%）Type Ⅲ.The 4s integrated relaxation pressure（4s-IRP）of pre-POEM were（28.32±11.14）mm Hg.After POEM,4s-IRP decreased to（11.34±6.99）mm Hg,71.6%（58/81）of patients returned to normal（< 15 mm Hg）.The lower esophageal sphincter pressure（LESP）of pre-POEM were（36.47±17.84）mm Hg.After POEM,LESP decreased to（16.99±7.66）mm Hg.The length of muscle incision was measured during POEM.According to the length of muscle incision（≤10cm）,67 patients were divided into short muscle incision group and 14 patients were divided into long muscle incision group.There were 55 cases（67.9%）without any signs of peristalsis,both pre-POEM and post-POEM,including 38 Absent Contractility（AC）,10 Achalasia TypeⅠ,6 Type Ⅱ,and 1 Type Ⅲ.Some degree of "peristalsis recovery" after POEM based on HREM criteria was observed in 26 patients（32.1%）,including 17 cases of Ineffective Esophageal Motility（IEM）,6 cases of Esophagogastric junction outflow obstruction（EGJOO）,and 3 cases of Distal Esophageal Spasm（DES）.2.The comparison of HREM parameters between the peristalsis recovery group（n=26）and the non-peristalsis recovery group（n=55）showed that the pre-POEM IRP and pre-POEM LESP in the peristalsis recovery group were significantly higher than those of the non-peristalsis recovery group.Logistic regression analysis showed that there were no predictors of ’peristalsis recovery’ among the analyzed parameters.Among all the subtypes of Achalasia,the incidence of ’peristalsis recovery’ was higher in Type Ⅲ（75.0%）than in TypeⅡ（39.1%）or Type Ⅰ（16.1%）.But with the exception of Type Ⅲ,which had a limited number of cases,the ‘peristalsis recovery’ occurrence of Type Ⅱ was more likely higher than that of Type Ⅰ.3.The effect of myotomy length（cm）in POEM on peristalsis recovery is not statistically significant（P=0.160）.There was no significant difference in Eckardt scores among different subtypes before the operation,but the scores of all subtypes decreased significantly after the operation,and there was no significant difference in symptom score improvement among different subtypes（P=0.05）.There was no statistically significant difference in Eckardt scores between the two groups after POEM with or without peristalsis recovery（P=0.391）.Conclusion:After the EGJ obstruction was removed through the POEM,32.1% of Achalasia patients appeared ’peristalsis recovery’ based on the esophageal manometry,which may be related to the Achalasia subtypes.Except for Type Ⅲ Achalasia,Type Ⅱ is more likely to appear ’peristalsis recovery’ than Type Ⅰ.No predictors or clinical associations were found to be associated with this phenomenon. |
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