| Objective:Achalasia is a rare disease,characterized by swallowing the lower esophageal sphincter(LES)is not completely relaxed,distal esophageal peristalsis lost and uncoordinated contraction,the remainder of esophageal lead to food transport damaged,food retention within the esophagus,main symptom is dysphagia,chest pain,reflux,along with the transfer of the illness,weight will decline,seriously affecting the quality of life.As an incurable disease,achalasia has been treated palliatively to alleviate its typical symptom--dysphagia.The current treatment methods include oral drugs(calcium antagonists,nitrate esters,anticholinergic drugs).Meanwhile,it is also treated by traditional endoscopic therapy(balloon dilation,Botox injection and stenting),surgery(Heller myotomy)and per-oral endoscopic myotomy(POEM).POEM has the advantages of small trauma,quick recovery,low cost and high safety,so far it has been widely used in clinical practice.Nowadays,more and more people at home and abroad use POEM to treat achalasia,gradually replacing laparoscopic Heller myotomy as the mainstream of the treatment of POEM.Studies on POEM at home and abroad are also increasing year by year,but there are few studies on the efficacy of POEM in Northeast China.Therefore,this study aims to evaluate the effect of POEM on achalasia of cardia in northeast China.Methods:Patients diagnosed with achalasia and received POEM in our hospital from 2017 to 2022 were included.A diagnosis of achalasia was made in patients with relevant symptoms(Eckardt score > 3,the sum of scores for symptoms of dysphagia,reflux,chest pain,and weight loss.According to the score of dysphagia,reflux,or chest pain(absent,0;occasionally,1;daily,2;after each meal multiple times daily,3)or the extent of weight loss(none,0;< 5 kg,1;5-10 kg,2;> 10 kg,3))and patients with objective evidence supporting the diagnosis of achalasia.Preoperative fasting for 24-48 hours and water deprivation for 6 hours were required to ensure gastric emptying.The patients were fasted for 72 hours after POEM and treated with proton pump inhibitors and antibiotics.Before discharge,Barium X-ray was performed to evaluate the passage of contrast agent in the cardia,and high resolution manometry(HRM)was performed to evaluate the pressure of the lower esophageal sphincter.Follow-up was conducted 6 months after discharge,and the data were collected and analyzed in time.Results:A total of 75 patients diagnosed with achalasia and received POEM were enrolled(mean age 48.8 years;39 women).The mean preoperative Eckardt score was8.60.There was a significant difference in Eckardt score between pre-operation and post-operation(8.43 vs 1.76,p < 0.0001).Barium X-ray before discharge indicated that the contrast agent could pass through the cardia successfully,and high-resolution manometry revealed decreased pressure of the lower esophageal sphincter.Sixty-five patients(86.7%)achieved clinical remission,that is,Eckardt score ≤3 points,and 10 patients who did not achieve clinical remission were investigated for their reasons,and it was found that the high preoperative lower esophageal sphincter was a key factor influencing POEM efficacy Conclusion:POEM is safe,effective and minimally invasive for patients with achalasia,and the short-term efficacy is satisfactory;preoperative lower esophageal sphincter pressure may affect the efficacy of POEM in the treatment of achalasia. |
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